First Aid to the Injured 5th edition c.1901

FIRST AID TO TH E INJURED

Honorary Associate oj the Order oj St. John. Honorary Membo)' oj, and Lecturer and Examiner to, the Association. WITIT

CHAPTER ON STRETCHER TRANSPORT, By Sir JOITN FURLEY, Knight of Jl,siico ajthe Ordel' oj St. John.

Also a CrrAPTER (being the Fifth Lecture for Females only), by E. hlACDoWEL COSGRAVE, MD., F,R,C,P,I., IDliJht of On((e of tli e 0 l'dc?', of fit. Jol' ll, I[o?lOJ'aJ'lJ Lifc Memb er I!'; al/d L£'ctm' {' 1' aJ/d E.wmim?' to, the A ssociatioll. FIFTH EDITIO::-r OF 130,000 to 180,000.

Price Is. net; by post, Is. 2,1, TO BE OBTAINED AT sT. JOHN'S GATF, CLERKENWELL, LONDON, E.C.

qJ;ue of tbe ®rl:ln of tbe

of $t. .3Jobn of ]rnl%alfnt in QCnglanlJ.

Ullb' t}afr.on .of ®xb.cr.

His most Gracious Majesty King Edward VII. ilri.or.

His Royal Highness the Prince of Wales, K.G. -lhior. VACANT. .of Qtllk

His Royal Highness the Duke of Connaught, K.G. (It£e.cniiut ®.ffi.c.cn.

f'relate-His Grace the Archbi,hop of YORK. CII(lIlccllol'-The Right Hon tht! Earl ECEKfo:\ OF TATTO:\. SCCIetaYl,-Gem:ral-Colo;ld Sir Ht,;IWERT J EKYLL, K.C.J\LG., P.1 • FI:J';SIlFIELD, Esq., LL.D. "PIIl .J/,:r--The Rev. Canon DucKwolaJl, C. Y .O., D.D. R ",I,'islrttr-Lieut.-Colonel GOl:Jl.D (;enealog,st-The Rev. \Y. K. R. M.A. Director-CClll'ral 0/ Co-c7Il(}niL's - Sir ALI3ERT \\T. \\'OllLJS, G .C.V.O., !Z.C.B., K.C.l\1.G. (Garler) _

Director n/ tILe A1Ilbulance Dc/arillle1l1 Thi.: Hon. the l\lar'lu"", of K.C.. [. :[,r..,riall-Lieut.-Colonel Rlcl! \IW HOLBECHE. .)'caelaly-Colonel Sir }[FIWEHT C. PE1WOTT, l hrt., C.L\. jerustlh'/J! '1 he

Cfl/',! Salcla,)! 0/ flie A 1//1'11/1111(( Dria/ {mellI-Colonel Sir HEI,tJlla C. PER1WTT, C.1:.

@ffiuX's.

A ssistallt Director 0/ tlu A IJIbulance Deiartmen/-Lieut C I I SI'r Rlcil \RD T E:lII'I.E , Ht.. C. LE 0 one _-I "'s,:lallt H.\:\sl1:\ Esq., 1\1._\. Ass/.slant Llbranan-CvRIL Ass/stant Sl'o-etmy-LOCKII'\RT STOCKIIELL, Esq. R. EUII'AHDS, Esq., A .C.A _ HOIl••SI!C",:e/({Y11 0/ tIle Britislt (J/>lttlzaJ/IIic . (.\cl1ng) Colonel C. :\1 WATSO:-'-, C.B., ,jer1{saiem-

A SI.'cretary (for ScoU/lltd) if the Britislt Oplzthal ' . oSl'lfa, erllsalcm-.\. A. Esq

The Council con".i<;ts th" . ub-Prior, as President Executl\'(; Officer" and the following ex-oYc/v, tl:e . ft1cmbrrs:

SIr JOliN FL'RI EY. C. B.

Colonel. J. C. D \L1'O:-'-, R'L\.

The RIght H on. 'Viscount K:-'-UTSFORD, G.C.l\I.G.

T.he Right Hon. Lord l\[osTn

S Ir JAMES N. DICK j' CB R.N. ' \. ... ,

Colonel C. " '. BOII'DLER, C.B.

n.Qt

Sir DYCE DL!cKWORTH :'I[ D \\'IU.LI:l1 • 17 (1 J\I.D.'

Major-General Sir OWE1\' T. BL!RXE G C.I. F., K.C.S.T. '

Sir .GE<lR(a.: ]-LWTER CHUBB, H".t, l\IaJor-General The Right HOll. Lord CHEYLESMORE.

The Chapter consists of the Knights fT' d S the Executive Officer ; the <0fficirrting Q[f)rrpTllins

The Sub-Dean of tht. CHAPELS I TJ R 'So , ROYA l C V 0 D D Ie ey. ell' 1,IlRH,\D.\ILE SAI-ORY "' . . ., ' • Bart., :'I1.A. , '

Hltiqhfs of QIir,m, I

The Hon. the l\IAI;QuI::SS tW (lRTILnIPTO:\ Gener:1 Sir F. \\'. E FORFSTlt,;I,\\ '\LKH, C.C.B., G.C.1\I.G.

Colenel c. i\J. RUYllS C 13 M.P. ., .. , r:lnluND 01\ EN. Fsq F.R.C" Jo PII'I'! H,\"so-.; FI LSIIFlT' LI) Esc] 1\[.,\. . , .. , I

B 2

{[f)e foHoming are 1!1nights of justin:

H.R.H. The Duke of CA:lIBRlDGE , The Right Hon. Earl EGERTON OF K.G. TATTON.

H.R.H. Prince CHRISTIAN OF Colonel The Right Hon. Lord S CHLESWIG-HoLSTEIN, K.G., "VILLI AM CECIL, l\I.V.O. G.C.B . EUWIN FRESlIFlELD, Esq., LL.D.

H.R.H. Prince CHARLES OF DEN- (Honorary COllllllander.) J\IARK, G C.B. His Grace the Duke of Fwr., K .T

H.H. Prince ALBERT OF S CHLES- The Right Hon. Lord BRASSEY, WIG-HoLSTEIl', G.C.B., K .C.B . G. C.V.O_ The Right Hon. Viscount

H.S.H.TheDukeofTEcK,G.c. V.O. TOWN

H.S.H. Prince FRAl'CIS OF TECK, The Right H on Earl A:lIHERST. K.C.V.O., D.S.O. The Right Hon. Vi<count KNUTSCaptain H.S.H. Prince L ouIs OF FORD, G.C.M.G. (J[ollorary BATTEN BERG, G.C.B., R.N. BaililJ) ·

The Right Hon. Lord LEIGH. R. MACLEAN l\f AcLEA'J, TREVENEN JAMES HOL- ARTHUR FRANC.S LEVELAND, C.B. SON-GOWER, E<;q.

Major Sir J OSEI'H WALLIS Lieut. Colon el F A. H EYGATE O'BRYEN HOARE, Bart. L AMBERT

CHARU:S P EMBERTON CARTER, Esq. Col. CIIARLES "VV NDHAM ::\I UHRAY,

Sir J. FURLEY, C.B. (Holt Bailiff). C.B., l\I P Lieut.-Colonel GOULD H UNTER- The Right Hon. th e Earl of RA:->Wr.STON (J-{Olt. C(lJlllIlander). FURLY, G.C l\I.G.

The Right H on . Lord STANJ\10RE, The Right Hon. Lord SA:->DIIURST . G.C.J\-I.G. G.C.S.1., G.C.I.E.

FRANCIS ROBERT DAYIES, Esq.

Sir HENRY A. 13LAKr., G .c. l\ T.G.

Sir BROOK K AY, Bart. Captain ATHAN IE!. GEO. PH1I II'S

Sir T. NORTH DICK-L.I\UDER, Rart. The Right Hon. the Earl of;\I EAl H

Major Sir ARCHIOALD LAMB, Bart. .1\. EmlU:--ID FRASER. F-q.

Col. Sir HERBERT C I'ERIWTT, The Right Hon. Lord \T OSTYN Bart., C B. Colonel CHARLES H UNTER

T he Right Hon . Earl FERRERS. The M ost Hon . the Marquess cf

RUPERT C ARADOC BRE,\DAl.BANJ7, K.G. Esq. His Grace the nuke of D,

Col. Sir J AS GILDEA, C.V.O., C.B. K.G., G .C.V.O. HENRY J OHN LOFTUS, Esq. the Right Hon. Earl Colonel BETHr.L l\ I ART I:'-I DAWES ROBElns, K.G., K.P., V.C.

The Right H on Lord 01' ROBr.RT l'lWDENFLI.CAlaJ7R, , H ACKNEY F.R-C.S.

Lieut -Gen. Sir CHAR1.ES \V ·\RREN, n AY FORllES, Esq. , G.C.M.G., K C.R., R.E. F . R.C.S. (l<:din.) f'olonel TAMEs CECIL DALTON, R.A. Colonel TOHN Au-:x\ tlb)l Lieut.-Colonel GOU1.D STUA-RT, C.B., C l\I.G. HU);TER-WESTON,D .S.O ,R. E. triJe foHominll nre tr)e .%ub ·Wrrlatcs:

'The TJord Bishop of ELY.

The L ord nishop

I

The Bishop o f GIBRALTAR . Tl.e Bi::.hop in

BEING THE AMBULANCE DEPARTME TT OF m:lre UJtiot2: of ibe ®rbet of tbe of .:6t. .3JoUlt of in 'WntrO:l.

HIS MAJESTY KING EDWARD VII. (SOVEREIGN HEAU AND PATRO;-,i OF THE ORDER.)

HIS ROYAL HIGHNESS THE PRINCE OF WALES, K. G. (C;RANn PRIOR OF THE ORDER ) ([mtml I1Frrcutiue Q[omUliitrr.

Consisting exclusively of Members and Associates of the Onler. Dlluto?' (>f tl:e Ambulallcc DI'j>artll1ent and Cilairllla.,t 0/ COlJlllliiia-

The l\Iost H on. the Marquess of BREAnALllAC-;I', K.G.

Assistant Dinctor and Dcfmty Clzai? man - Lieutenant·Colonel Sir RICHARD E, Bart., C.l.E. Eejlll).-Cltairman.-Sir JOHN FURLEY, c.n., (Life J\fember of the Committee IfOllon's Causa). fil,:lJlb:rs.

Colonel J. C. DALTOI', R.A.

The Rev. T. W. W OOD. l'vlajor-C;eneral ASTI.EY TEnRY.

Colonel C. \Y. C. B.

\ \' . COLLI:--IGIlIDGE, Esq., M.U.

Colonel J. W . OTTLEY, C. 1. E.

Inspector-General B. NINI'IS, l\I.D., R.N.

In::.pector-General S ir H E"RY r"REDERlCK N ORBURY, K .C.B., M.D. , K . H . S., R.N. (Director-General, Me dical Department, Royal Navy. )

S. C. W AR[)r.LL, Esq.

S urgeon-General J. J AMESOK , c.n., M.D.

S lIrgeon -l\Iajor-General Sir J OHN By COLE R EADE, K .C.B.

G. S . ELLISTON, Esq .• M.R.C.S.

QI::entrnl

CHRISTOPHER CHILDS, Esq., IIl.D.

Surgeon-General Sir JOSEI'll FAYRf:R, Bart., h.C.S.I.

CH.\llLES J. TRDlBLE, C.J\1.G., L.R.C.P.

Surgeon-General Sir \VILLIA\! R. HOOI'EI/, K.C.S.I.

Colonel CLE:lIE)'!T n[ oL\'1\IWX RO\'Ds, C.B., ilL 1'.

Captain J- W. NOTT BO\\,F.ll.

Surgeoil-Gener:J.ISir \VILLIA:l1 TAYLOR, r;:'.C.B., "\1.1). , KILI'_

(Director-General i\rmy ilIedical Scn ice)

ED:lIUND O\\'EN, Est], F.KC.S.

The Hight Hon. Lord CL.-\l,ll IT A:l111

The IIlost Hon. the iI[arqu.:s" of Su:, I H.UIP10:--:.

Lieut.-Coloncl ,\. C. V.ITE.

Sir WIl.Ll.\:l1 IJF:':-:ETT. K.C.\'.O., F.R-C.S. H.EGI:'HLD H,\IIRISO:-:, Esq., F.H.C.S.

Lieut.-Colonel E. \\'1 LS"", C .B , C.ilLG., D.S.O., R \.:'I,C

Surgeon-General ,\. hF.OC;Il. C. IL, IIl.V.

Lieut.-Colonel W. !3\BTIf:, C . .\I.(;., r.(![., R..\.iiI. C'.

Sir EIlI\AI,O L. LE\,.

Colonel GEORGE H. O'iI[ \LLE\" R.,\. for. Cn\TFS, R.N.

JOH)'! ASTLE\' BLOX \:11, Esq., F.H .C. -.

Ex-O.fJio·o II/tJ.lbt'l'S oj' Commit/ceo

Colonel Sir HERDERT JEh:\,LL, E... R.E. (Secrctan··Gcncral e:C the Order). -

ED\\, I', l'ESHFIEl.D, Esq., LL. D. (Recei ,'er-General of tire Orde'·).

Thc Right Hon. Earl EC'['I<TClX OF TXl'TOX (Chairman, llrili,i, Ophthalmic Hospital).

(I[ fJ irf rcrrtnrJ}.

Colonel Sir HERBERT C. PERROTT, Bart., c.n., (Sccret:uy of 1lH: Olller).

aniJ

\V ILUA.\I R. EDW.\RDS, Esq., A.C.A.

(.Iccoltlltall t O/' !/ie Order).

"-1miJ @ffirrs.

ST. JOHN 'S G,\TE, CU.,RKE:--lWELL, LO:\TDON, E.C.

Tckgrajllic Address-" Firstnid, London." Tclcpllon<-Holborn, e(,l.

18anJ\CI F.

LONDON A;o;D WEST:"IINSTER B_\:\T K, LDIlTfD, (Lothbury, E.C.)

R ,EYISED 1901.

AID TO THE INJURED.

SYLLABUS OF INSTRUCTION.

A. Preliminary remarks, of Instruction, &c.

B. A brief tie cript; iJll of the Human Skeleto!l, BOllt'" Joints, and the Muscular 8YStClll.

C. Signs, symptoms and treatment of Fractures, Disll cations, Sprains, and 'trains.

D. The Triangular Bamlage and its application.

8ECOND LECTURE.

A. The Heart anu Blood Vessels. Tho Circulation of tht>Blood.

E. The general direction of the Artel'ie , the points where the circulation may be arrested hy mgIta pressure, or by tho application of the tourniquet, or by cthf" means.

C. The difference between Arterial, Venous, and CapIllar y anLl the various extemporary means 01 arrcstm;:? It.

D. The Triangular Bandage and its applic:ltion.

8

THIRD LECTURE.

A. brief description of the Nervous Syster... n. persons from shock or colbpse InjUry, .mJury to. the bram, collapse from drink, famtmg. hysteua, sunstroke, electric shock, effects d llghtmng, and convulsions in children.

,C: First in cases of burns or scalds, injury by vltnol throwmg, wounds, bItes of animals, stings of insects.

D. 'Vhat to ([0 whcn the dress catches fire

K The Triangular 13Jndage and its FOURTII LECTURE.

A. , A ?rief description of the Organs and Mechanism of Respll'atlOn.

D. The treatment of the apparently drowned or sullocated. Artificial Respiration, Treatment for Chokmg.

C. First.Aid P9isoned.

D. The Immed Iate FIrst Aid treatment of injuries to the Internal Organs, and to those suffering fr om Intern 1 H ze morrhage .

K Foreign Bodies in the Eye, Ear, and N 03e . .

FIFTII LECTURE (for males only).

A .. Improvised methods of lifting and can'yin er the si, Ie or IDJLU'ccl.

0

D. Methods of lifting and carrying the sick or inj nred on strctcher.s.

C. The conveyance of by rail or in country cal ts.

FUTII (for females only).

A. Preparation for reception of Accident C1SOS.

B. Means of Lifting and Carrying.

C. Prep 3.rJtion of lkd.

D. Removing the Clothes.

E. Prep3.rJtions for Surgeon.

NOTE I.-The subject of poisons should be treated in a general manner. The common poisons classified, and only thcir general symptoms and effects taught.

To get rid of th e pois :m is the only treatment which can be safcly practised by llon-professio nal p erso ns; the administration of antidotes is the m edical man's duty.

NOT!>; n.-Th o last half hour of eac h lecture should be devoted to practical work, such as the application of bandages and splints, lifting and carrying wounded on stretchers.

NOTE III. -There should be an interval of a week between each lecture . A Cantliuate for examination mnst attenu at least four out of the five lectur03

NOTE IV.-Male classes rou·t pass in that system oE stretcher exercise most suitable for the locality.

KOTE V.-As little time as possible is to be spent on instruction in and physiological details. Lecturers and Examiner>; are particularly requested to remember that it is "Fir.:;t A ill" that has to be taught and tested, and not anatomyal1ll}lllysiology.

CIIAPTER I.

Explanatory

T he Human Skeleton. , pine, skull, ribs, breast. bone, upp er extremities, pelvis and lower extrem ities, and joints ."

Muscles. V oluntary and involuntary

Fractures. Causes, ,-arlctie3, signs and symptoms ...

General Treatme nt of Fractures. Apparatus, splints and bandages. General rules for treatment

Treatment of Special Fractures. Spine, crani um, lower j9.W, ribs, breast- bone, collar·bone, shoulderblade, arm, forearm, metacarpus, finger, pelvis, thigh, knee-cap, leg, foot ..

Dislocations, Sprains, and Strains

CHAPTER II.

Circulation of the Blood. Organs; general , lung, and liver circulations; the heart, arteries , veins, capillaries, blood, course of eirculatlOn

Hremorrhage or Bleeding. Artuial, venous, capillary

Arrest of Hremorrhage. Pressure, direct and indirect; insl rumenta l (by tourniquet), and digi tal; fi:exion, position of ratient, eltwalion of limb ,"

Course of the Main Arteries and Arrest of Arterial Hremorrhage. The aorta, arteries of the head and ne ck, of the upper extremities, within the chest a nd abdomen, of the lower extremities.. .

Venous Hremorrhage. Varicose veins

Ca pillary H a:morrhage ...

CIIAPTER III.

The Nervou3 System . Cuebro-spinal, sympathetic

Insensibility. General treatment, examination of patient, shock, concussion and compression of the brain , apoplex y , collapse from drink, epilepsy, fainting, hysterical fi ts, sun stroke, electric shock , eftects of lightning, convulsions in children ...

CHAPTEH. IV.

\Vounds and Injuries to the Skin. Th e skill, bruises, wOllnds, frost· bite, burns and scalds, wbat to do when the dress catches fire, vitriol throwing, bii;es of animals, snuk€ bites, stings of jnsects, &c . ...

"1IIAPTER V.

rhe Respiratory System

Artificial Respiration. Sylvestcr's, H oward's, and Laborde 's methods

Drowning. Strangulation, Choking, Hanging , Suffocati c n

CliArTER VI.

P oisons and Poisoning, Simple directions for t reatmen t . l'oisons and their treatment classified: -Narcotics, inebriants, delirients, corrosives (acids and alkalis), irritants... . . ... ..'

CrrAPTER VI r.

lnjuries of Special Organs. Foreign bodies in the eye, ear passage and nose. The chest (thorax) and organs contained in it (heart and lungs), wounds of th.e In.l1gs: .The abdomen and the organs contamed m. lt (!lver, spleen, intestines, kidneYR, bladder), wl th tle3tment of injury to them. Rupture ...

CLIAPTER Vln.

Bandaging. Application of the t riangular bamb,ge to th e scalp, forehend, &c., shoulder, hip, hand, foot, chest, back, kne e, eibow

CHAPTER IX.

Carrying Patients . Four, two, and three-handed fireman's lift, temporary stretchers, to cross a dItch or wall, to 103d and unload a w.1.gon

Treatment of fracture of thigh (man)

Treatment of fl'adure of thigh (woman)

Fracture of knee-cap

Treatment of fracture of knee-cap

Treatment of fracture of leg

One form of dislocated shoulder ...

Principal blood vessels anel organs of

Diagram of circulation of the blood

Field tonrniquet

Screw tourniq net

Digital compression of c:lrotil1 artery

Arrest of hremorrhage from temporal artery

Arrest of hremorrhage from fore11c:u1

Arrest of hremorrhage from palm::tr ...

Digital compression of radial anel ulnar arterie;;

Flexion of elbow

Digital compression of brachial artery from belo\\'

The same from above

Compression of axillary artery ...

Digital compression of subclavian artery

Flexion of knee-joint

Digital pressure on subclavian artery ...

Application of tourniquet to femoral arter.\-

Brain and spinal cord, and nerves proceeding .l1'OIll it .. .

Oiagram of magnified section of skin

The lungs and bronchial tubes

ArtificiaJ respiration: inspiration

Artificial respiration: expiration

The organs of the chest and a bdomen

lhnclage for head ,..

Bandage for shoulder

n l1lr1age for hip

J3anlhge for hand

Bandage for foot

13?nt1age for chest (front)

Bandage for chest (back)

Bandage for knee '.'

Four-handed seat

Two-hanued seat .. , ,......

Alternati ve grip for two-hanll.ed seat

AnoLher alternative grip for same

Three-handed seat...

Fireman's lift (carrying) .. .

Fireman's lift (lo'wering) .. .

Seat improvised :vith P?les and coat .,.

Stretcher improvIsed wIth poles and coats

Stretcher improvised with poles and sack

Furleyordinary stretcher (closell ) ...

Furley telescopic-handled stretcher (open) A

PREFACE.

-- <i> --

AT the request of the Central Executive Committee I have written this manual as the official handbook of the St. John Ambulance Ass( ciulion.

The strides. made in the teaching of "First and the reqUIrements of the St. John Ambulance Brigade, have necessitated an enlargement of previous works on the subject published by thc AEsociation.

I h a:e endeavoured to include only as much anatonllcal and physiological detail as is absolutely to enable students to grasp intelligently prll1Clples of treatment.

The gr.eater part of the directions for the application of 'n' bandage and for lifting and carrying patIcnts, I S adapted alrr:.ost verbatim from the \York of the late Surgeon-Major Sh epherd, as l'e-written by Dr. Hob ert Bruce.

_ I wish to express my thanks to Colonel C. Bowdler, Drs. J, Brown, C. Ohilds, M. Ooates, 'V. Collingridge, J. Ii. Crease, G. H. Darwin, and H. A. Latimer, who have, as 9, sub-committee of the Association assisted me in my work. '

JAMES

J-une, 1901.

Ji{TRODUCTION.

THE St. J ulm Am blll:1DCe Associalion has corn pleted tbe t\ycnty-fourlh YE:ar of its existence During the period since the Asso ciation began its work, hundreds of thousands of m ell alld 'YOmell haye occn tangllt at tbe classes of the Ausociati on how to help th eir injured neighbours, III eyery COUll try ,vhere ciyilizution has penetrated d oes the teachiog of Association nnd a ready audien ce. All ranks 01 bociety testify to tb e usefulness of the instrnction g iY en, The follo'iyers of no r eli g ious or political creed eavil at its aims and id eals. Jew aml Gentile, Chri stian and Mahol1ledan, Brahmin and Buddhist, aceo pt its tenets, and appreciate the benefits it confers.

Under' Lhe auspiccs of the St, John Ambulance Association, "First Aiel )) has developed into a distinct branch of surgery, n ecessitating a special training. N either in 0111' medical schools nor in our hospitals is "First Aiel " speciu1ly tanght, and it is to the initiative of the St. John Ambulance Associ:1tion that both the and the lll(·dical pro[ess:oll arc indebted for haying deyelopecl and taught tlti::. llnportant department of general Sl1 rgery. C

The instruction begins and ends with "First Aid," and the subject is taught thoroughly and exhaustiyely. The duty of the ambulance pupil ends where the doctor's commences, and there ought to be no overla.pping or clashing of duty or interests. No more liberal or useful instruction has ever been given to the public, and the work of the St. John Ambulance Association must continue whilst charity remains to us, and sympathy for suffering humanity endures.

FIRST AID TO THE INJURklJ.

CIIAPTER 1. EXPLANATORY.

oJ First Aid I; is meant that form of skillc>D assistance persons trained in ambulance ,,,ork can afford instantaneously to the sick or injured.

" First Aid to the Injured" is a branch of surgery demanding special training and education.

The principal aim and object of the St. J olln Ambulance Association is to teach in simple language how to help <t sick or injured person until the service of a doctor are obtained. ';}

A further and important branch of ambulanc6 work is the carriage of sick or injured persons by stretcher, by ambulance wagon, by rail, or by improvised means of transport.

Before proceeding to gi ve in detail the yarious steps to be taken in the event of accident or suelden i11nc::5s it is necessary to know something of the strilcture of tb e body (elementary anatorr.y), and the fUllctions of some of the more important organs hnd system ' (elementary physiology). A short descriptic 11 of n ecessary anatomic:).l and physiological of importance are therefor" given as the several subjects c :2

are in detai1. It is esse;'ltial to remember J.Y}lCll studying anatomy thL'"tt the human body is supposcd to uo standing erect, with the palms of the hamls directed forwards amI the thumbs out,mrds, or aWA:T from the hody. The" middle line" of the body \.., <t ciraWll vertically from the top of the head to " point between the foet.

") THE SK ELETON.

The lluman body is moulded upon a bony f!'Hme work whiGh serves: (1) To give shape and 1I1'111110S::; to the uody; (2) to afford attachment to the muscles ' and (3) to protect the more vital orgallJ in in the cbest, and in the abdomen.

_ The uoncs or a dried skeleton represent onl V the earthy matter of the bones-the bone salts jU the animal matter of the living bOlle-the bone tisSlleamounting to one-third of tile wbolo, has disappeared. When Ol1e of tlle long bones of the Ii 111liS , sl1ch as the thigh oone, is sawn from end to end, it seOll to consist of clellse, com]7(1ct materi:;li, coYel'ing a more open, honey-combed looking tiSSue, the cancellow3 luaterial of bone. The compact tissue is thickest in the middle or shaft of the hone, the cancellous at p,ithcl' end. The centre of the bone is uut it \, occupied during life by marrow.

THE BACK BONE, SPIXEJ OR VEIlTEDlUL

The Vertebral Column. -E..n.ch scgm,:-nt (X which the spine is composed is termcd a Vcrtebra.

A Vertebra consists (1) (.,t a central bouy (.1' mags 5 (J) of processes, two of ,,,hich join bchinu to form

SURFACES SUPPORTING HEADS

a canal for the spinal vord-the Spinal C:.tnal; behind, bony projections-the spines of the vcr tebrm -can be felt oeneath the skin for the whole Jcngtl} of tho bllek.

The Yel'tebnc, 33 in all, are grouped into regions:I. The Neck 01' Cervical vertebroo are 7 in nllmPQr: the first 01' atla.s forms a. joint with the base or the skull, at which the nodding movement of thl' head ta.kes place: the second or axig, by the joint

BODY OF VERTEBRA FlO. 1.

OF RIBS

botween it and the atlas, allows of the side to side movements of the head.

II. The Back or Dorsal vertebrm, 1 in number, have the 12 pa.irs of ribs attached on either side.

III. The Loin or Lumbar vertebrre, 5 in number, are the largest of all the vertebn:e. IV.

The Rump Bone or Sa· crum consists of five vertebrm, united in adults as a solid mass, "hich, with the two haunch bones, forms the pelvis. V. rrhe Tail Bone or Coccyx consists of four vertebn:c which are

FIG. 2.

SKULL A:"D VERTEI3HAL CO,XMN, Showing lefl ribs an i 7Jor· tion oj llrea8l·uone. The right 1"ibs a?'e 1'e?1wvp-d. 23

joiued together to form i1 single group. The vertebrre in each region are known by numbers, counting downe wards-1st, 2nd, 3rd, etc.

Between the bodies of the vertebrre thick pieces of gristle or cartilage are interposed (intervertebral discs), which, whilst they bind the bones together, allow of free movement to the column as a whole, and serve to break the shock of allY sudden force applied to the spine. The whole length of the spine is strapped together by ligaments reaching from end to end of the column.

TrIE SKUI,L.

The bones of the skull are arranged in two groups, tho:;e of Lhe brain case, or cntnium J and of tIle ffU:C.

The boundaries of the Cranium are the vault or dome, the rounded portion forming the top of the head; the front or brow j the back of the head, where the greatest extent of brain exists, and where, therefore, the cranium is widest and deepest; the s:des or temples, where the openings into the ear passages are seen, and to which the ear is aUnched. The base of the cranium is hidden from view by the bones of the face ano thf' verfebml column: in it are n:lmerous perforations for the passage of the blood vessel::; going to. and from the brain; through the largest opening the braiu and spinal cord al'e continuous. 1

The bones of the Face, with the exception of the lowe.r jaw, are firmly jointed together, so that mO\'ement between them is impossible.

The cavities of the nose and of the eye socket (orbit) are formed by the bones of r,he cranium and fa.ce conjointly.

The mouth cavity is formed between the npper and lower jawa, the palate being the bony roof of the rnouth, which separates it from the nasal (;!ayity aboye.

THE RIllS.

The Ribs consist of twelve pairs of cuned bones extellJing from the vertebral column behind to the front of the body, and are known by numbers, 1st, 2nd, 3rd, etc., commencing from abo\'e. They form joints wi th the dorsal vertebrro, and their movement that of the handle of a bucket. The ribs are not, hmvever, bony throughout their entire length .Q At a short distallce from the breast-b one the bolly material ends, and grisUe (cartilage) takes its place The 11pper seven pairs, named the true ribs, are attached by their cartilagca to the breast-bolle; t he lower five pairs arc termed the false ribs, as their cartilages fall short of (he midJJe line. Of the false ribR tIle 11th and 12th tp,rmed the or wII1.'!cd )'i IJs, . s their c'nd arc free in frollt. T!w

25

ribs enclose the chest, and serYe to protect th o lungs heart, liver, st01ll<1ch, .'plecll, (sec TIIOl\lX and AbdolLlen J.

THE BREAST-nONE.

The Breast-bone (sternum) is a dagger-shaped bone with the point below, jnst over the pit of the stomach; it supports the inner ends of the collarbones above, and the seven true ribs are connected with it on either side.

THE U PPEIt EXTREMITIES.

The Shoulder bones are the collar-bone (clavic1e) and the shoulder-blade (scapula), and they constitute an imperfect girdle-the shoulder g irdle. The Collar-bone l.an be felt beneath the skm at the lower and front part of the neck as a narrow curved rod of bone, abont the thickness of a fiuger. Its inner end rests on the "upper part of the breastbOlle; the outer end joins with the shoulder-blade at the top of the shoulder; at either end a joint exists. The colhr-bolle is endowed witl) cxtra eJI1Rticit,v, owing to its being possessed of a double curve, the Inner two-thirds of the Lone being curved forwards and the outer third backwards. This is necessary in order to resist the strain thrown on the Lone Ly falls 011 the hand, elbow, or shoulder.

Til e Shoulder-blade, flat and trianglllar i!l O Il C-

.ARl\! BoNE (HUM E RUS).

FOTeann { ULNA Bona. RA DIUS \ VRIST (CARPUS ) -----} ---i f! ---{ .

FlO. 3.

line, lies at the back of the chest. A large process of this bone at the top of t he shoulder, joins with collar-bone, to gIve squarcness and prominence to the shoulder, and protects the shoulder joint immediately beneath it. A surface on the outer angle of the s houlderblade formb the socket of the shoulder joint.

The bone of t he ann is rounded in the centre of its shaft and expands above and below to take part in DuNI S (1<' TIlE LEFT UPPER h EXTREUITV . t e formation of the . " shoulder and elbow

JOlllts

The upper end presents a r Oll l1c(C L t Wt:ere It rests on the shallow surface formed to l 'OC,:8 l \'0 It by the shoulder-blade j the lower end is sbaped t o ftt tlle two bones of tlte forearm c.:.t the elbow

In the Forea rm are two bones, tho Radius on the outer, or t.humb side, and the Ulna on the inner, or little finge r side. Both bones reach from the elbow to the wri ·t, and they change their relative pORition with every turn of the band .

Tbe Hand is composed of: (1) the bones of the wrist or ca1'PVS, eight in number, arranged in two rows of four; (2) the metaca1'pus (the framework of the palm), p resenting fi\Te bones. which form the knuckles and support the bonos or the fingers ; (3) the phalanges or finger bones, three in each fiuger q and two in uhe thumb.

TilE PELVb LOWER EXTllEMITlES.

The Pelvis .-Tb e large hasin-like mass of bont. att::tched to the low er p:lrt of the spine is composed of three bones, the two haunch "Lones and tho sacrum (or rump bone ). The haunch bones meet (at the pubes) in the middle ]inc in front, only a slllall piece or gristle but, behino, the sacrum is placed between them. The pelvis servos to snpport the abdomen and it.' contents, to protect the within the pelvic cayity, to give attachment on its outer surface to the muscles of the hip and thigh, and presents the deep socket for the head 0f the thigh bone-Lhc hip joint.

FLO. 4.

TUE nONES OF 'THE nrCUT

TIIlGII BONE (FEMUR).

KKEE CAP (PATELLA).

BROOCnnOI'E (FmuL.\).

fllTN (TWIA). TARSUS.

METATARSUS. PlIALA:\OE8.

The Thigh bone (/e7J11.lJ') reaclles from the hip to the knee joint. The shaft of the bone is stout, rounded, and arched fOl'wal'Js. The upper end pro.. sonts a rounded head, supported on a neGk which projects inwards at an angle from the shaft oJ tho hOlle to fit illtO the socket of the hip joiut. 1'110 10\\'01' end expands to form two projections n.t the knee joint.

'rhe Knee Cap (patella) is a thick triangular piece of bone with its ba.. e upwards lying in front of the knee joint and the lo\\'er end of the thigh bono. It can be feit immediately beneath the skin.

The bon es of the leg are the Shin hone (tibia) and the Broo ch oone (titmla.) The Shin bone (t£lJia) is triangular ill shape. It extends from the knee to the ankle, into both of whicll joints it elltors and plays an importltllt part. The sharp edge or :-:hin can be felt immediately beneath the skin of the front of the leg; at the iuner siele of the ankle a stout piece of bone projects downwards from th e tibia. The Brooch bone (fiuula) 1ie'S parallol to, and 011 t.he onter side of, the tihi ll., This bone docs not entor into the formation of t be knee joint, bu tits lower end forms the onter bounda.ry of the ankle joint.

Thp, Foot.-( I) The group of irregular bones at tho instep constitutes the ta?'SlIS. Thore are SeY8n bone in the tarsus, of which the largest is the heol bono, a.nd the uppermost (the ankle bOlle) forms the lo\\'er p .:trt

Df the ankle joint. (2) rrhe long bones in front of the tarsus constitute th e metatct1"sus, and each bone supports a toe. (3) Each toe, except the big toe, possesses three bones, named the 1st, 2nd, and 3rd phalanges. The big toe h as t\'1"0 phalanges only.

JOINTS.

A Joint is formed at the Junct ion of two or more IJolJes. In joints such as the hip, knee, elbow, etc ., the surfaces of the bones are co\'"ered by gristle or

FIG. 5.-THE HIP .JOINT.

Section of a Ball and Socket Joint.

cartilage, a harel, dense, semi-translucent covering which lessens friction and tbe violence and shock of

31

a fall. Lubricating the joint if:> a dear, rather stichy or syrupy fluid, the "joint oil," or synovia, enclosed within a cap.sule. Tying the bones firmly together, but yet allowing of movement, are a number of bands or ligaments. Bones, cartilage, synovia, capsule, and ligament are therefore the component parts of the limb joints.

'1'0 explain the formation of limb joints, the following examples are given :-

1. The Sho" (dcr, a ball-and-socket joint, consists of a shallow saucer-like surface all the outer angle of the ,boulder-blade (scapula), and of the rounded head of the arm-bone (hnmerus). Owing to the sballowness of the shoulder-blade surface, the round end of the arm-bone is yery prone to escape from its socket (dislocat8).

2. The Elb'Jw , a hinge join t, composed of the arm-bone above, and of the two fore-ann bones below (the radius and ulna). '1' be upper end of the ulna forms a stout projection behind-the tip of the el bow - which . erves to emb ra.e e tbe ar111-bo ne and maintl.ill the bones of tbe elbow joint in position.

rrHG MUSCLE,'.

All thp movements of the bo::1y are due to 111n cular fiction. Populn.r1y the muscles at' term e 1 "the ilet-3h," awl many believe thai He Rl! und mnscle n1"0 different The erroneous bc}jef comes ab:H1t

in this ,vay. -When an animal, such as an ox, is tied up and fed lib erLt.lly , the muscles become soft and charged \vith fat, and form palatable and nutritious food; on the other hand, when an animal, such as a ho.1.'se, lrel::i its rml'clcs for severe \york, they become hard and tough and unsuitable for food. Both are, however, mn ,cle or flc:::;h under different conditions.

The mu:::;dc:::i ot the body are cla 'sificd into tw o groups, the rolzlJItaJ'!/ and the i1l'l;ollllltul'!1 7Ilw:!cZes.

The Voluntary muscles arc composed of muscular they constitute the main bulk of muscles met with in the limbfl, the head and neck, and the stuface of the trunk. These muscles arc attached to the bones, and ()s they pass from one bone to another they cross a jOillt, aud Leing endowed with the po\yer of contracLion and relaxation, canse the moyements of the body. A a mu ele crosses a joint, it 10 es its red, fleshy appearance alJd become , a tendon (leader). To understand better the anatomy of the mu ' c1e, take as an example the rectus muscle of the thigh. The rectus arises from the pelvis, passes over the hip-joint as tendon, becomes fleshy (muscular) in the middle of the thigh, and finally crosses the knee-joint as tendon to reach the tibia. Blood YC sels travel'se and supply tho muscles, and the nerves entering the muscles bring them under t££ direct control of the brain and spmal corel.

'rhe Involuntary muscles are composed of D

FIG. G.-DiAGRAM SIIO\YI.'G RECTGS MUSCLE OF TilLH, \Y1Til AH.TERY, Al'D NERVE,

muso1e cells. to form extensive layers j they are met wlth m the walls of the stomach and lntestines, in the air passages, and in most of the internal organs and blood vessels, also in a special form in the heart. The involuntary muscles are not under the influence of the will, but 00ntinue their work during the hours of sleep; they are supplied by a separate set of nerves (see Nervous System).

FRACTURES AND THEIR TREATMENT.

By a Fracture is meant a broken bone.

CAUSES OF FRACTURE.

A bone may be broken by:-

1. Direct Violence. When from a severe blow, impact of a bullet, or crush of a wheel, etc., a bone breaks at the spot where the for(',e is applied, the fracture is termed direct.

2. Indirect Violence. "\Vhen the bOlle lJreu,ks n.t some distance from the seat of injury, the fracLure is termed indirect. Alighting on the feet and fracturing the thigh-bone or the bones of the leg, or falling on the hand and breaking the radius or the collar-bone, are familiar exampleR.

3. Muscular Action. The knee cap and the arm bone (humerus) are occasionally broken by a violent contraction of the muscles attached to them.

35

VARIETIES OF FRACTURES.

1. . Simple. The bone is broken in two with but slight injury to surrounding parts. '

2. Complicated. The bone is broken and other important adjacent structures injured either by the

FIG. 7.

DIAGRAM OF SlJIIPLE FRACTURE OF LEG. F IG 8.

DIAGRA?llOF COMPOU n FR.\CTURE OF LEG , WITfl BO)TE PROTRI10I(\G. n2

viobncc which caused the fracture, or l>y the sharp elldt:> of the b0118 \\OLLDding a blood ves 'el, nerve, or allY of the organs \vi,thin the skull, chest, or abdomen.

3. Compound. The b011e is broken, the skin tissue::; punctured or torn, th8 air to communicate with the seat of the fmctlll'c. Th e fractured end may protrnde through the skin, or the: WOH nLl maT lead down to the fracture. The yiolenc.;e: th1:LW broke'the boue, or the jagged elld::; or the bUllU them elves, v pecially during c<1l'elest:> movement, llloLY cause a fracture to become compound.

6U;)WING FRAOTURED PRJPERLY AND IMPROPERLY

Passing reference may [I.1so be made to three more ",arieties. Com ::.rn in ute d :- The brme is smashed into several pieces. Green-stick :-In children, o-ring to the softer state of the bony tissues, a bone may bend and crack with out breakin g completely ac:ross. Impacted :-When, instead of overriding, the broken

ends of a bone arc driven the one into the other tho is said to be impacted. Several of tbe SIgns and symptom of fracture rnelJtior 3d below are absent in g r een-stick and impacted fractures.

SIGXS AND SnIP'l'OMS OF FRAC1'Ul1E.

1. Loss of Power in the limb.

Pain at or near the seat of fracture.

3. Deformity. The injured limb lies m an ... position, and i8 mi8-'ha]len at the ':'cat of the ll1Jlll':J".

4. Owing to the contraction of the musc1e8, the ends of the bone override cansilW shortening of the injured limb. '0

5. Swelling, The overriding ends of the broken llone, the contraction of the muscles and cffu ion of blood, will cau e the parts around the seut 01 the fracture to increa e in bulk.

G. Irregularity. If the fractured bone is close beneath the skin as in the case of the jaw collar-bone shin-bone, etc., the gap in the bone 01: ends of fragments may be felt by the finger.

7. Unnatural Mobility. '- :Nlovement may be made out at the scat of the break in the bone a' ,yell as at a jo int.

_ 8. Crepitus or bony grating may be felt or heard when tllo broken ends movo one upon the other. The last two signs 8hould only be sought by a surgeon.

AppARATUS FOR TREATMENT OF FRACTURES.

Splints and Bandages are the apparatus by which broken bones are to be treated. In hospitals splints and bandages, appropriate to every variety of fracture are at hand, but for "First Aid" treatment they freq ue '. ly h ve to be imprrvised.

Splints m :.y be improvised from walking sticks, umbrellas, billiard cues, bro . m or brush bandIes, a policeman's truncheon, a musket, a bayonet or a sword in its scabbard, a folded coat, any piece of wood, firmly folded newspaper or any other paper, a rolled-up map, or, in fact, anything that is finn and long eno'ltgh to keep the immediately abov" anr.l belo?I} th e f1'actu1'ed bone at 1·est.

Bandages may be improvised from handkerchiefs, belts, straps, braces, neckties, or any piece of hllen or cotton that comes to hand.

Esmarch's Triangular Bandages (Fig. 10) are made by cutting a piece of linen or calico forty inches square into two pieces crossways. The bandage may be used either as a broad or narrow b.1udage.

The broad is made by spreading the bandage out, then bringing the point down to the lower border (Fig. 11).. and then ioli1ing into two (Fig. 12).

The narrow is made by folding the broad bandi:tgc again in two (Fig-. 13).

BORDER.

FIG. 10. BANDAGE SPREAD OUT.

BORDER.

FIC. 11. ONCE FOLDED. LOWER BORDER..

FIG. ] 2. DR8AD BANDAGE.

-_

LOWER BORDER.

FIG. 13. NAlffiO.V

The bandage should al",ays be fastened by;) pin or by tying the ends with a reef knot (Flg. 14).

FIG. 14.

When used for splint", the bandage hould ue folded narrow, and may be applIed either Fw.15.

(1) by pasi3ing it once, twice, or more round the limb and splint and tying with :1 reef knot; or (:d) by

41

it, passing it round the limb and 6plint, 111se1 tmg aile end through the loop formed by

FIG ISD.

FIG. l6A. the banda.ge a::1u tymg [1., to the free end with a reef knot (see Fig. 15 ); ?l' (3) by proceeding a , III No. but passing hoth ends through the loop in opposite directions (see Fin·. 16A), and tying them with a reef knot (see Fig. 1Gn). Knots should ahmys, where possible, be tied

over a splint, so that they may not press upon soft structures to do them injury.

Large arm -sling (Fig. 17).-Spread out a bandage, put one end over the shoulder on the sound side,

FIG. 17.

let Lhc. other down ill front of the chest; carry thc pomt behmd the elbow of the injured arm, and bend the arm forward over the middle of the bandage; th.en carry the second end oyer the sho ulder of

the injured side, and tie to the other end j bring the point forward, and pin to the front of the \bandage.

Small arm-sling (Fig. 18).-Fold the bandage

18.

into the broad bandage j theE. place one end over the shoulder on the sound side ; cross the forearm over the middle of the bandage hanging down the chest;

FlO.

44

the other end over the shoulder on the slde, and tie at the side of the neck.

.Slmgs may be exten:porised by turning up the t::ul of t he coat and pmning it OJl the shoulder

FIG. 19.

(Fig. 19), or if the seam of the slee" :) h, l '> hC(,ll fo;lit up, b:>: resting the arm in the strip of cloth w) f();·.n8u, ;llld pmning as shown in Fig. 20 .

45

GENERAL RULE,' TO BE OBSERVED IX TIlE TREATMEXT OF FRACTURE.

The objec t oE first aid treatment of fractures is to guard against fluther mischief, and especially to preyent a simple fracture from becoming complicated or compound. To attain this end :-

1. Attend to the fracture on the spot where the accident occurred. K 0 matter how crowderl the thoroughfare, or how short the listance to a more conve nient or comfortable place, no a.ttempt l"!lLlSt be made to move the patient until the bone has been rendered as immuvable as possible by a .. plint or oth er restraining apparatus. 'With this great principle established, the treatment of special fractu res is a question of detail.

2. Steady and support the injured limb at once, so that its further movement on the part of either the patient or the bystanders is prevented.

3. 'When a bone of the lower extremity is broken gently pull upon the foot until the limb regai ns a more normal shape. 'Wh en the position of the limb is improved, on no account let go of the limb until it iG secureJ in position by splints, otherwise the muscle I will be allowec1 to contract, and the roug h endu of the urokcll bone may penetrate the skin, pierce a blood-vessel, or do further damage. It is not weU to attempt extension (i.e., stretching) in c::ts...

of a fracture of the upper limb. This should be left to the surgeon.

4. When the fracture is compound and further complicated by severe hremorrhage, arrest the hremorrhage before further steps are taken. !n all cases of compound fracture, apply clean dressmgs to the ,vound.

5. Apply splints and bandages to secure the limb in position, and to prevent movement whilst the patient. is being carried to his home, to a hospital, or to temporary shelter. The splints should be long enough to keep the joints immediately above and below the fractured bone at rest.

6. In every case of fracture, it is necessary to keep the patient warm, so as to lessen the effects of SHOCK of the accident; this is done by placmg a cloak, shawl, or coat over the patient until he reaches shelter.

SPECIAL FRACTURES.

Fracture of the Spine. - When the backbone is .broken in any part, there is great danger of the or th e nerves within the spinal canal bemg l?Jured, thereby causing complete or partial paralysis of the parts below the seat of i:ljury. vVhen the fracture occurs above the 4th cervical (neck) vertebra, death is instantaneous. 'When the spine is broken below the 4th cervical vertebra the patient may live some time, or may recover with or

47

without co mplete or partial paralysis. The principal sign of fracture of the spine i therefore inability of movement every where below the seat of fract ure. Treat ment.-Prevent all movement on the part or the pa.tient. If a doctor is within call, keep th e patient quiet until he arrives. If the serv ices of a doctor cannot be obtained within rea 'onable time, pass a hlanket, she et, stout plaid, piece of sailor canvas, etc., beneath the patient. Do not roll the patient over in doinO' so, but pass the blanket or h eet., etc., ca refully first °beneath the head, then behind the body and lower extremities (or , if more convenient, begin by passing it from the feet upwards) as he lies on his back. Poles are then to be rolled. in the blanket one on each side. The patient may now be lifted by four persons, two on either side, grasping the poles (each person using both hands), laid on a stretcher or shutter, and can-ied to shelter. No further treatment is called for u ntil the doctor arrives, except to give the patient water, tea, etc. , if he is conscious.

Fracture of the Sku ll.--Fractures of the cranium are dangerous in proportion to the extent of the inj ury to the brain contained within its boundaries. Usually there are symptoms of injury to the brain (see Compression and Concus ion, pages 111-113).

Fractures of the vault are l ess dangerous than fractu'l"es of the base of the cranium . "\Vhen any part

of the. vault IS fractured and a scalp wound reveals mJlll'ed hone, the fracture may be seen or felt; thIS mayor lllay not· be associated with evidence of bralll injury.

"When the base of the cranium is fractured, blood or dear fiUld may issue from the ear; or the blood may escape from the nose, or may pa1\s down to the stomach whence it may be vomited. The f "' dure may involye the orbit, \vhen blood will escape into sO<.:kets of one or both eyes. When the fracture is fur back, there may he indications of a bruise at the buck of the head.

Treatment.-Arrest any hremorrhage froll a bloodvessel in the scalp (see pages 83 and 84). Place the patie-?t in an easy position to breathe; undo all tight clothmg; carry the patient indoors or under shelter; apply a clean handkerchief, a piece of lint or linen dipped in cold water, or, if available, an ice-bag, to the head. Do not give anything by the mouth if the patient is insensible, and get a doctor speedily.

Fracture of the Lower Jaw. -There a1'3 the of with inability tv sp2ak or move the Jaw freely, Irregularity of the teeth and bleeding from the glllllS. '

17reatme1lt.-Place the pn.lm of the hand belolY the injured bone, press it gently up\vards against the upper jaw, and maintain it in that position by a narrow trin.llgubr (or handkerchief) b:1l1dage. To

49

apply Ll1e LJallljage, J.?lace the centre below the clUll, carry the ends up the side of .the head, crossing them Just above one ear, and pass the end round the head, tying them on the ide of the head oppo ite to the crossing (Fig. 21). Another method is to tic the ell(1::, on the top of the head, and rass a second bandage in front of the FIG. 21. chin, fasten the ends at the back of the neck. and tie all tour ends on the crown of the head.

Fractured Ribs. -The ribs usually fractured are tho e occupyinO' a central position in the chest, namely, the 6th, 7th, 8th and 9th. rrhe high?r and the lo,ver pairs nre , cldom fra.ctured. A nb may be broken by a direct blow or by a .queeze or crush. It may be brcken ill any part of Its course, but it is usually fractured halfway oet"ween the breast-bone and the back-bone. The danger of a broken rib varies with the arnount of injury to lung. Practically, wherever a. rib is to felt there IS lung beneath; therefore any force. "\,luch tends to drive the ends of tbe broken bone lllwn.rdl::l may tear the lung.

50

51

Signs and Sympto?ns.- When a rib is broken the patient. complains of a severe pain, Oll attempting to take a deep breath; the breathing is short and shallow, and crepitus may be felt on placing Lbe hand over the injured part. Should the rib penetrate the lung blood may be coughed up and mood coming from a torn lung is congbecl lip, It is oE a bright red colour, and presents a frothy 11 ppearunc8.

'1'l'eatm'3nl.- TT71en the lllnu is not il7jU},(l,l apply two bl'oud bandn.ges firmly round the chest, with the centro of one bandage immedi1:l.tely a10yo, alld the centre of the secoml 1andage immediately below FlO. 22. t he seat of fracture.

,rhen 110 ln1.11dages are procllrable, tightening tIu: "ai.:itcoat bv pinning tho back 01' securing it otherwise is a good plan. TVhen the ?'ibs are broken, CaW,i!l!Jv!tjl/l'!J lu, !lid it lIIay lJe ITu:,:fhe lun!/, clo not pbce a b::tnrla,ge ronnd the body, 1lllt lay th e p'1.ticnt c10 1\'l1, inclined n litLl e the side, ill ol'clcr t give more play to the lung j IOJ.3cn the dothing, gi \\; icc to suck, and place an ice-bn.g on the che ·t. 0\-01' the rib. A bandage rOllllu the chest mIght to dl'lve the broken cone furth er into the llmg. A lnrg", ::.ling to sr:.LJport the arm oE tlHJ illj llrell s:c'J i.s advisa1l e in either C'tS".

The hanch.ges are to be plcwecl so tha,t the lo\\'er oycrlupR the upper to balf its extent. They are to bo tied on the opposite side of the body with the knot rather to the frOll t of the body, and tight enough to giYe the patient SlI pport and comfOl t ill brcathiug.

Fracture of the Breast -bone (.4f/'l1ltm).-,Yhell this accirle::J.t is sLlspected, or wh en by pas:::,ing the oyer the Ul'c<lst-bone the fmc:tnre can 1e a.ctually the tl' eallw'l,t to be followed is, to undo a.ll tigh t clothing, to pbcc the patient in as easy n position as po::;silllo until a doctor c.1.lTives, and to ayoic1 1'0Llgh lUll Cllillg or sudden UlOYelllent.

FHACTUfiE OP THE OF TIlE UrrEIl EXTTIE;\1fTY.

Fracl ure of the Collar-bone (r-1an'tle).-Thc arm on tho injured siele is partially helple s, and the patient usually snpporl1-; it at the elbo\\' witll his kl.l1d, and inclines his hend to." a 'ds the illjureJ side. \Yhen the finger is passed :lIang the injured uone the

fractured ends can generally be felt to oyerlap, the outer fragment having dropped below the leyel of the inner one. The other signs and symptoms of fracture are mostly present.

T7·eatment.-Remove the coat with great care,

FIG. 23.

beginning with the sound side and supporting the injured limh during the removal of the sleeve therefrom; also take off as much more of the clothing, as expedient. Place a pad about t.he size of a Bath bun in the armpit of the injured

side. Gently bend the forearm well up, and supporb 111 a large arm sling. Instead of applying the

FIG. 24.

hrge arm sling in the usual method, it is advisable to pass the ond, that ill t.he ordinary way would go over the fractured bone l beneath the armpit of the injured

ide, and tie the euds uebind (Fig. :?;3); uJ this IJhm bone is not Ijressed 11pOll by the balldagc. 1, mally, tIghtly securc the limb to the side of the lJody by a broad bandage, applied immediately Oye1' and .upOl1,.t be. :lbow of the illju]"cc.l '0, a sllown in Oll tlmo (1, 19. :2:3); carry the ends honzontally round tbe chest so as to leyer out the arm at the shoulder joint, forming the fulcrum. 'Wh on Olle Inl11clage only IS ayallaule place a pad in the armpit, flex Lhe forearm in. dingram (Fig. 24), apply a llanO\\" bandage Immodlately aboye the elbow, bring one end the front of th() chest; carry the other end behJl:d the arm, amI then bring it forward between Lhe 11mb and the body; pass it so as to emhrace the portion of the bandage on the front of tile and finally carry it rOl1l1d the baek; pull tight al1d tie off as in diagra m.

Fracture of the Shoulder-blade (sraruln) to treated, the clothing is rcmoyed, by applyIng a broad tnanguln.l' bandage firmly roulld Lhe body, o,or the seat of injury, and theret'(\]'c dose up to the armpits; the limb is then supported by a lurge arm sling.

Fracture of the Arm (hlllnP7·W;).-The bone may be broken close UP to t.he Rho111der in the . middle of its shaft, the immediate hood of the elbow J<Ylllt. The usunl signs and Bym.ptoms are present.

55

Treaf7ncnt.-JVhen the HumenlS is jTactu7'ed at its 1IPlJCi' f'7lcl close to tile shoulder joint :-A pply a broad banda.ge ,yith its centre aboye the middle of the arm, and carry the ends round the arm anl'l body, tying them on the opposite side j support the forcarm by a sm.all arm sliug. TVlzen the shajt oj the lIumenlS is broken :Benel the forearm at right angles to the arm; apply four splints of wood or folded ne"wspapers, co,ers of hooks, etc., to reach fro 111. shoulder to elbow, to the from, back, outcr, <z inner sides ot i he

FIG. 25. arm (Fig. 25 ; . Tho splint in front (over tbe biceps muscle) must on no account be so long as to press upon the fold of the ellnw joint, otherwise the blood· vessels are in danger of b:;ing compre-sJqd . 'l'he straw co \'er of a wine bottle cut to a proper

56

length forms an exr::el1ent splint for the front of the arm. In case of difficulty in procuring splints, it will be sufficient to pla,ce them on the outer and inner sides only. Secure the splin ts by two bandages, one aboye, and tho other belo,,' tbe seat of fracture. In case no splints arc ayailabJe, seClll'e tho arm with two broad. bandages to the side. Support the forearm by a small ar!1l sling. Fmct11res £n the nez'ghbo1trh()od oj the elbow }oint are to be treated by an angnlar splint (Fig. 26) made as follows: - Take two pieces of thin flat wood, one long enough to roach from the armpit to just below the elbow, the l!'rG. 28. other long enough to reach from above the elbow to the finger tips; tic them together 30 as to form a right angle, and apply the angular splint so formed, on either the outer or inner side of the flexed limb. Secure by narrow baud:1ges above and below the seat of fracture) and ::::upport bv a sJnQ,U arm sling. ...

Fracture of the Forearm. Signs and Sl/mpi'o1n3.-1Yken bot "JJ (the Radius q,n:l U.na)

57

a?'e broken, the usual signs and symptoms of fracture are present; when one of the two bones only is b1'oken the signs are modified, but the limb will lose power, a deformity will be found at the scat of fmeture, and acute pain when movement is;attempted.

A fracture of the Ulna alone usually occurs at the upper end of the bone, in the neighbourhood of the elbow. The tip of the elbow behind is formed by the ulna, and a fall upon that process of bone is apt to break it off.

The Radius is frequently fractured immediately above the wrist, the result of a fall on the hand. This fracture is usually impacted and the signs of fracture are consequently modified, but the deformity, the acute pain on movement, and the powerlessness of the hand are sufficiently strong uroof that the bone is broken.

FlO. 27.

Treatment.-The treatment is the same whether the fracture is of one or both of the bones. Bend the forearm at right angles to the arm, keeping the thumh upwards and t.he paIn: of the .hand towards bod? ; apply two broad splmts whIle the IS rnaIlltained ill the bent position, one along the lllner, the other along the outer side of the limb. Tile inner splint should be long enough to reach from the elbow to the fingers, and the outer from .the elbow to the back of the band. Secure the splmts by bandages, one above, ::md anotber belo:" the of fracture, and a third to fix the hand III pmntlOn (Fig.27). Finally, support the limb by a brge arm sling.

Metacarpus.-One or more of the metacarpai bones may be broken by direct or indirect violence. "When a metacarpal bone is fractured, place a round pad, such as a tennis ball, in the palm of tbe hauel, bend the fino'ers round the ball, and secure the \\"h018 o . by a bandage, and apply a small arID Sllllg.

Fracture of a Bone of the Finger :7Ihalarzx;.--The nature of the injury is readily recogllir.able, as the deformity can be both seen and felt.

-Treatment.-Draw ' the injured finger gently into position, apply a narrnw splint along the front of the finger, and secure it by a piece of linen, tape, or plaster. 'Vhen several fingers are injured apply a splint large enough to support the whole hand. Support the hand and forearm by a large arm sling.

59

Fracture of the Pelvis.-Signs and SYlllptoms.

- ,Vhen, after severe injury in the neighbonrhood of the baunch bone, tbere is no sign of injury to the lower extremity, but the pa,tient is unable t() tand, or walk, or even to move the 10\\'er limbs, ,,-iLlI out great uiffieulty and pain, a fr[1.ctnrc of tbe pelYi" m[1.y be assumcd to have occmred. Deformity, crepitus, etc., can110t usnally bc made onto Tlr.e bloou-vessels a11 (l organs, more cspeei::t11y the bladder, within the ]Jchis, are in great danger of being wounded.

Treatment.-Lay the patient in whatcver position is founrl to give greatest case. Biud [1. broad balldnge round the bips tight, enough to sl1pport U:c p.lrt, but not so tight as to press the broken bOllC Luther inwards towards the cavity of tbe pelvis, nlld thereby cause 1110re damage to the internal orga!l . Flex 01' straighten the lower limbs according as tllc patient ,,-is11e , and lay him c[1.refully on [1. blanket, shutter, or before moving him to [1. place of shelter.

FRACTURE O:F TilE OF TilE LOWEn

Fracture of the Thigh bone (femlti·).-The thigh bone mH,y b v br kcn at the neck (th9 upper encl); anywhere in the length of its shaft; or at the lower end dose to the knee. FmcGme of the neck

of the thigh bone is very apt to occur in old people, and from very slight injury. A severe bruisp. of the hip is apt to be mistaken for a fracture. It may 1.>e taken as a safe guide, however, that when, after an injury in the neighbourhood of the hip joint the injured person can, whilst lying on the back, raise tue heel off the ground, the bone is not broken; but it the heel cannot be raised it is safe to assume that the bone is broken. Fracture of the lower end of the thigh bone is apt to involve the knee in the injury, with serious detriment to the joint.

Signs ancl Sumptoms.-The usual signs of fracture. The foot of the injured limb will lie in Rome abnormal position, usua.lly on its outer side. The shortening on the injured side may vary frvill. one-haH to three illches.

l'1·eatntent.-(l) Steady the inj ured limb by holding the foot. (2) Gently draw dmn1 thc foot of the iuj ured side, and bring it into line with the foot of the sound limb. 'Yh en two or three assistants are at hand, it is Olle person':::, duty to attend to the foot, llOlding it in position and not letting go until the splints and bandages are l1.pplied. (3) Apply a splint on the outer side oE tue broken limb, long enough to reach from the annpit to beyond the foot. A broom handle, a musket (butt end in annpit), a school map rolled up, a couple of Lilliard cues tied together, or any piece of wood cut to length

be used as aspEn t. (4) APIJl y a splint on the mSlde of the broken thigh, long enough to reach from the inside of the top of the thigh (the fork) to the knee. (5) Secure tue splints in position by banc.h,ges. Pass one round the chest just below the armpits; another round the pel vis ; a third and fourth ba?dage, embracing both splints, are placed on the , tlllgh, one abo\e and the other below 1he seat of f1 ncture; a fifth bandage round the leg; a sixth is to be passed behind both ankles, the ends crossed

FIG. 28.

over the front of the feet, embracing the splint, and tied ofl" below the feet. Finally, apply a seventh bandage round Loth knees. Do not apply a bandage over the abdomen, as it might cause the patient to vomit, and, moreover, would not keep the splint firm. (6) Treat shock by keeping the patient warm. TVhen a pe1'son is single-handed, it is expedient, after extension of the limb, to tie the feet together by a handkerchief or brace) to prevent the bOlles from again ovcrlapping· and under these circumstances} as well as when

62

patient is n. womau, it if; Vlell to pass all the limb uandages ronno. both limbs, dispelLing with th" inside splint (Fig.

FIG. 29.

Fracture of the Kneecap (patella) - The kneecap may be broken by falling on the knee Yiolence). More frequently it is broken l)y nnlDclllal' n.dioll , an accident wbi Lh mav ari se as follo\y s : \\"ben the foot slips and an attempt is m ade to preyent a £.,1.U, the muscles in the front of the thigh act 'with such force in the attempt to maintain the balance that the kneecap may be Dnapped ill t,,-o.

Sig7tS and Symptom.".. - The limb will be C]uite helpless; a gap mn.y be felt bet'ween the broken ends of the kneecap; tLe 1\l1ee joint ,yill "peedily swel1.

Treatment. -- Straighten the

FIG. W. FRACTUR!l: limb. Apply.a splint along the back OF KNEE-CAP. of the limb, reaching from the lJip

63

to bCIJond the heel: apply a narrow bandage with its centre placed immediately above the broken kneecap, cross the ends behind over the splint, [.lIld tie off in front below the broken bone. ro ensure firmness a second bandage may be applied in a imilar \yay to the first, out commenced belo\\', und tieu aboye the broken bone. The splint is to

F ::o. 31.

be fnrthel.' secured by bandages round the thigh and leg. The foot is then to be raised well off the ground, and supported 1y n. pillow, roll of clothing, etc. ; 01' if none of th ese can be Imd, by resting the foot of the inj ured limb on the top of the foot of the sound limb. The pa.tient's body is to be well raised n.nd Sllpported. An ice-bag or cold-water dressing should be applied on the front of the injured kneecap 6.i3 soon aG pos",ible.

Fracture of the Leg (tibia and jilJula).-Both bones may be broken at the same time; or either may be broken alone.

Signs and Symptoms.-The usual signs and symptoms are present: pain, deformity, immobility, crepitus, etc. The tibia is so close to the skin that the fractured ends can generally be readily felt. A fracture of the fibula three or four inches above its lower end is frequently mistaken for a sprain, and not infrequently for a dislocation of the aukle, owing to displacement

FIG. 32. of the foot being the most prominent sign. ,Yhen one bone only is broken there will be no m:1rked shortening.

Treatment.- (1) Steady the limb by holding the foot of the injured side. (2) Draw the foot of the injured side level with the foot of the sound limb, with the toes pointing upwards, and do not let go until tile splints have been fixed. (3) Apply to the leg, one on the outside, another on the inside. Tho splints should be long enough to reach from above the knee to beyond the foot, so that the knee and ankle joints

65 are kept at rest. If only one splint is ayailable, place it on tho outer side. (4) Secure the splints by bandages placed one above and another bolow the seat of fra.cture. A third handage to be applie l immediately above the knee, and :\, fourth and fifth round both ankles and knees as ill the case of the thigh. fVhen single-handed, after extending tile limb, tie the feet together, dispense with the illside splint, and carryall bandages 1'0ull<1 both When no splint is available, tying the legs, ankles and knees together is of great se rvice.

Fractures

of the Metatarsal Bones and Phalanges (crushed foot).-Fractnres of these bones are commonly caused by the passage of a benxy weight over the foot. The accident is recognised by pain on movement of the foot or toes, swelling and loss of power.

T?'eatment.-The treatment consists in the application of a flat splint of wood or other material, such aR a book or piece of cardboard to the sole of the

DISLOCATIONS.

A dislocation is the displacement of one or more of the bones entering into the formation of a joint.

The joints most frequently dislocated are those of the shoulder, the elbow, the thumb, the fingers, allu the lower jaw. The joints of the lowei' extremity are but seldom dislocated.

SIGN H[PTD:llS OF DISLOCATION.

(1) Unnatural position of the limb. . (2) Pain of a severe sickening characte r .

(3) Deformity in the neighbourhood 0'£ til';) injured j oint.

(4-) Fixity of the joint. Unlike a fracture, t!lC limb cannot be moycJ. at the joint by either the patient or ot ll crs.

(5) SwelUng and numbness of the parts below the seat of dislocation.

(6) Absence of the crepitus characteristic of ordinary i rl1ctur0. OF DISLOCATIONS.

o n.tte:npt should be 111'1,(13 by anyone except a doctor to reduce n. disloc:1tion. The following treatment, h oweycr, pcnding the ani val of the J.octOl', should b e ct),rri ed ont :-

When the Accident occurs out of doors.-

(1) In the case of dislocation of the shoulder, sllpport the upper cxtremity in whatever position gives most -case by a large anLl sling; prevent all jolting of the limb by tying a bandage round the limb and body or by pinning the sling to the clothing . 'When no means -<>f applying a sl in g are n.t hand, fasten or pin the coat

67

sl eeye to the clothing. 0) \V-h th l'b . . located t' f en e e ow IS dlsside of upper extremity to t h e y 111 1e most cornf' ·t bl .. pos'ible. (3) W'hen an " Ola e is di.sl.ocatcd lac h y. of the lower extremity . ,p etc lImb III the easiest 't' possIble and carr}' tIle p .. ' t ' J POSl IOn ! _ alolen on a stretcher t o house or home.

. When the pa. tIent is indoors.

-(1 ) Remove the from the joint and lrm b. (2) Place the patient on a couch or bed. (3)

Rest the limh on hion or pillows

Ill. the pO 'it'ion wluch affords most comfort. (4) App ly & cold (ice, or towels ""- wrung out of cold

F ' .... water) t o the dis-

O L •..).'3 ltd . . ."'E D,F DISLDC;TED SI oea e Joint. (5) IO ULDER ' VI to glye comfort apply warmth fial len. cold ceasea out of hot water) (6) , XTI ( 111el or towel wruncr h . f len the h k' b t e warm by an . oc - IS severe keep (_ propnatf' remedies. (See Shock). Ii' 2

SPRAINS.

When bv a sudden wrench or twist the ligaments a nd the pl'l:rts .around a aro and t he joint is sald to be spramed. GOIng over. the ankle is ono of tho commonest examples of an accIdent ot this AXD SYMPTOMS OF SPRAII'\S.

Sudden sovero pain aud inability to use the jOi.llt after a twist or wronch mark the occurrence of a spra1l1. Quickly the part swells and becomes II black and bbo )'-owing to the effuSIOn of blood into and a!.·oulld the jOillt. There is, however, no fractu re or d i 8pitu:cmollt of Lhe bones.

TnEAn[ENT OF SPUAINED ANKLE.

When at some distance fro m house o r home. -Do not remove the stocking or boot, but bin,d t he foot and ankle tightly round by a bandage (hanak erchief, strap, etc.). The bandage is to be passed below the waist of the boot, crossed on the front of the aukie, and then carried round and round the a nkle whe re it is firm 1v tied. Vvet the bandage eithe; befo re Gi' after· application; it is thereby t io-htened. After reaching shelter, lay the down, r e!I1ove, without dragging, the and stocking, cutting both if necessary; place the lllJUfed

69

part in as comfortable a position as possible, apply ice 'Or cold-water dressings to the joint as long as they relieve pain, and when they cease to give relief apply hot fomentations 01' a bran poultice.

'When other joints are sprained they require mucb the same immediate treatment as when they are dislocated.

STRAINS.

'When during severe exertion, as liftillo and pullinoheavy weights, muscles or tendons are o;er they are said to be "strained. l)

SiGNS AND SY,;}[PTOMS OF SrRAIXS.

a part is strained a sudden sharp pain occurs, r:ondermg further exertion painful, difficult, or impossible. If the strain hfts occurred in the back the patient may be unable to stand npright or take a deep breath without pain. 'iVhen in a limb, the strained muscle may swell, causing severe cramp-like pains.

TREATl\1ENT OF STRAINS.

Place the patient in as comfortable a position as possible, and apply hot-water bottles or hot fomentations when the Rain is very severe.

. A strain in the groin (rupture, or heruiu.),

18 an lDJury of a totally different nature (see page 1.64).

CHAPTER II.

THE ORGANS OF CIRCULATION.

THE organs concerned in the cir::l.llation of the blou\.l are the Heart , the Arteries, the Veins, and Capillaries. Tbree systems or groups of blood vessels are met \\-ith in the body :-

(1.) The General (or systemic) circulation III clnde' the circulation of the blood through the heart and all the blood-vessels of the limbs und trunk, except those of the lungs and liver.

(II.) The Lung (oj' pulmonary) circulation I:;; carried 011 by the pulmonary artery and yeins.

(III.) The Liver (01' poTfal) circulation. large vein (the portal) curries blood from thl stomach, intestines, the sple en und pancreas tv the livel'.

The Heart is situated in the chest llehind the breast-bone and rib cartilages, between the lungs and immediately above the diaphragm; the heart lies obliquely with a quarter of its bnlk to the right, and the remaining three-quarters to the left of the middle line of the body. The beat of the heart may be felt just below and to the inner side of the left uipple. The heart has four cavities, two on either ,j c1e of a central partition (septum). The two upper cavities are n:::.med the right and left auricles, the

L. Larynx (voIce bux); T. Trachea (wind-pipe); R.I.... Right Lung; L .L. Left I,ung (the lungs are to expose the he:trt and blood yessels); Rlght AUl'lcle.; L.A. Left Auricle; RV. Rlght VenLl'lcie j L.V. Left Ventricle; P.A. Pulmonary Artery; Ao. AO: Aorta: S.V.C. "' uperior vena cava (the large velll carrymg from the upper part of the body to the heart) j I.V.C. InferlOt' vena cava (the large vein carrying blood from the lower part f the body to the heart). The four p'ulmonary veins cannot be shown in the diagram.

two lower the right and left ventricles. In the two right cavities dark purple ( venmts) .blood is contained; in the left cavities the blood IS scarlet (a1'ferial) in colour. Valvep, are placed between the auricles and ventricles and at the commencement of the pulmonary artery and of the aorta; the valves are arranged so as to prevent the ward flow of blood wJwn the cavities of the heart dIlate.

The Arteries arc the vessels carrying blood from the heart to all parts of the body. The wall.s of an artery are endOlved with the pO'wer of expanslOn and eontraction, i.e., pulsation.

The Veins.--Every vessel carrying blood towards the heart is termed a vein. The walls of the veins are thinner than those of the arteries of corresponding size. In the limb Yeins, more especiuJly, valves are met with at frequent intervals, placed so that the !)acbmrd flo 'w of th€l blood is arrested. Veins running .mmediately below the skill arc termed superficial; those met with amongst the tissues and organs. of the body are termed deep veins. T.he deep vems, for the most part, accompany the . .

The Capillaries are vessels of mICroscopIC dI.mensions; they possess walls of such extreme that the fluids and gases of the blood and body gam ""')ntrance and exit through them. In this manner the .101uishment and maintenance of the tissues and I)rgans of the body arc provided for (sec pages 74,75). 73

The Blood.-The colour of blood varies in appearance. according to the vessels in which it flows. In the (of the general circulation) the blood is blood; in the veins it is dark purplevenous bluod; III the capillaries it is of a liaht red The in colour is caused °by the presence of oxygen 111 the arterial and capillary blood, and t!le pr.esellce of carbonic acid (and diminished quantIty of oxygen) in venous blood. Only in the lung or pulmonary sy tern do the arteries contain dark purple, and the i'eins scarlet blood.

TIlE OF THE BLOOD.

The i'eins the pulmonal'Y) from all parts of the body collect two large I'essels, ,,,hich discharge the "ellOng blood mto the right a.uricle of the heart. the right auricle the blood is driven into the rIght i'entricle, and hence by the pulmonary artery the Llood reaches the lungs, where it is changed to a. colonr-" ]Jurified "-by contact with the aIr. } rom the h:ngs the bleod is returned by t"3e four pulmonary velllS to the left; auricle. From the left auricle the blood passes to the left ventricle and finally is driven from the heart into the mai:'l of the body (the am'ta).

!he aorta is the great central blood ,essel from which the mai,n arteries proceed to all parts of the trunk and hmbs. The arteries are named accord.

FIG. 35.

DIAGRAM OF THE CIRCULATION OF THE BLOOD.

Explanation. I]'1 the middle of the is th,e heart with its four chambers. Above the heart IS shown tne lung ( ulmonary) circulation. The lower part the leneral (systemic) circulation contamlDg (venous) blcod are shown black, w.hlle those e (arterial) blood are shown whlte. The connectmg represent the capillaries. The arrows show th direction of the flow of blood. "i5

lng to the region of the body which they occupy : thus they are oalled femoral, brachial, carotid, etc., according as they are met with in the thigh, arm, or neck. The main arteries give off branches, and these in turn till smaller branches as their destination is reached. Finally, the small arteries end in capIllaries, wbere the 'oxygen in the blood is given up to the cells and tissues of the body. The capillaries now receive the carbonic acid and other waste pro· ducts from the cells and tissues, r.nd the blood becomes of a clark purple (venous) colour. The capillaries rass this blood on to the veins, ,,,hieb convey it towards the heart, getting larger and larger as they proceed hy being joined by neighbouring veins, until they finally reach the heart as the two large vo sels entering the right auricle.

The heart contracts in adults at an average rate of seven y-two ime' a minute, but the rate Yaries, incrci\, ing the position is changed from the lying to the sitting or to the standing positiol1. About two ounce (a ,,,ine-glass fun) of blood arc discharged into the aorta at eYery contraction of the left ventricle, and the blood is sent into the arteries in jets or waves, causing the puls e , which may be felt along the course of all the main a.rteries whcre,'er he finger can he placed on an artery as it passes over a bone. In tbe veins no pulse iR to be found, as tbe heart wave is expended during the passage of the

blood througn the capillaries and r educed to a regula.r and even flow.

H£MORRHAGE.

H::.emorrhage or bleeding signifies the escape of hlood from an injured or diseased bhod -yessel.

Arterial Hremorrhage. -BlooJ from an artery (1) is scarlet in colour; (2) escapes in spurts or jets corresponding to the pulsation of the heart; and (3) flows from the side of the wound nearest th3 heart. It is, however, chiefly when the wounded artery is close below the skin, as in the hand, foot, temple, etc., that the Llood may be seen to escape in jets. ·When the artery is deep scated, as in the leg, the blood may ilell up from the oottom of the wOllnd without marked signs of pulsation. The quantity of blood lost varies "\yith the size of the artery wounded. ·When the aorta, or one of the large arteries at the root of the neck is ·wounded, dec.tth is instantaneous; when the main arteries of the thigh, armpit, n-eck, etc., are wounded, death will occur in a few moments unless the flow is stopped. Pressure applied to medium sized a rteries, as those of the leg or forearm, within a few minutes of being wounded, will save life j hremorrhage from smaller arteries may cause serious loss of stre ngth unless the flow is speedily arrested.

Venous Hremorrhage.-\Vhen a vein is cut the blood (1) is of a dark colour; (2) it flows in a slow.

77

continuGus stream; (3) it issues from the side Of the wound furthest from the heart. Wounds of veins of the limbs are somewhat less dangerous than in the case of arteries of corresponding size.

Capillary Hremorrhage .-Blood flowing from capillaries, as from a slight wound of the skin: (1) is light-I'ed in colour; (2) flows briskly in a continuous stream; (3) wells up from all points of the cut surface.

GENERAL PmKCIPLES OF THE ARRE T OF ARTERIAL H1EMORRHAGE.

The principles of treatment to be followed in the event of bleeding from a large arter y ar e: 1st, to apply direct pressure on the bleeding point; and 2nd, if direct p ressure is unsuccessful or impossibl e, to apply pressure on the main trunk of the artery between the wound and the heart as close to the wound as possible. The closer to the wound the artery is compressed, the less will be the damage to the limb.

The means employed in the temporary arrest of hmmorrhage are digital and instrumental compression and flexion of the limb. Laying the patient down and elevatillg the limb will lessen the force with which the blood escapes.

I. Digital compression is tho application of the thurnb or fi,ugers either on the bleeding point

itseU-di1'ect comp1'ession-or on the trunk of the main artery leadin g to t h e wound-indi?'ect compJ'ession.

II. Instrumental compress i o n may also be applied by t h e direct and indirect method.s. (a ) Direct instrumental compression may be earned out by applying a h andkerchief, piece of lint or lir:en folded into a small , hard pad, and placed on the bleedmg point, where it is secured by a bandage firmly tied round the part. T o fold the handkerchief as a pads proceed as fo110',"8 :-Lay the handkerchi ef out on a flat surface; bring the four corners to the centre of the handke rchief; again bring the corners to the centre and con tinu e folding the corners towanls the centre' unti l the becomes a hard pad. The round, smooth surface is placed on the skin oyer the arte ry , and to prevent the pad unfolding, the puckered surface may he fixed by a safety pin, or stitched with a needle and thread, if sHch appliances are at hand . A hard substance such as a stone, cork, nut, marole, etc., may, if necessary, be enclosed in centre of the pad . Should occasion permit, a (lToduated compress may be made and applied a' f0110''''8: Place a small folded piece of linen or lint, or cotton, upon the bleeding poin t ; over this place a second and larger piece of thB same material; a third and a fourth or mo re pads, each larger than it predecessor, are superimposed , u ntil a regular cone is formed, with its point or apex resting on the and its base

d?wn by a tightly applied bandage. (0) znstrumental compression consists in stoppmg the of blood through the main artery by a tourl1lquet. A tourniquet is an instrument whereby pressure can be made on the trunk of an so as to stop the flow of Llood throuO'h it. A t o':rmq uet may consist of a pad to be l)laeed on th e tmn k of. an artery,. a strop ban 1 lage app1ied so. [t: the 11mb and pad, and a buckle, 8('1 el!, 01 twz<Jhng apparatus (such as a stick) whereby t o the strap or. The three principal tOllfll1q uets. are the 11TI provlsed, the fi eld, and the screw .tournlquets. are seldom applied t? the brachIal and femoral arteries. An Impro v ised tourniquet i made and applied as follow :-On the tl:unk of the main artery, Ray the femo:-al or the appl! a firmly folded pad, about the size of a tel1lllS ball cut III two for the thigh, and of a ,yalnut for arm; over this pad plaee th;:! centre of a 11arrow tna.ngular (or other) bandage , and tie the on sIde of the limb oppo ite to the pad. Afte.l the of the bandage i · made, place a stICk, penCIl, walking.stick, pol;:er, policeman's tru llcheon, or some such instrument, upon it, and then the knot, adding yet another half-knot for securIty. The" stick" is now to be bvisted when bandage will be tightened, and the pad pressed mmly upon the trunk of the artery with s:lfficien t

force to arrest the flow of blood. Should a suitable pad not be at hand, a knot may be made in the centre

FIG. 36.

FIG. 37. FIELD TOURNIQUET. SCREW TOURNIQUET.

of the bandage, and when available, a stone, cork, etc., enc10sed in it to give it firmness and bulk. See that the bulging, and not the flat, side of the knot is next the skin. The" stick" is finally" locked" in position by the ends of the bandage used for the or by another bandage passed round the limb and made to enclose and fix the stick.

The field tourniquet consists of a pad and strap. The pad is placed on the course of the artery

and fixed there by the strap, which is pulled tight and off. The screw tourniquet (by some constdered obsolete) acts on the same principle, the strap, how.ever, being tightened by a screw apparatus. An elastic bandage passed round the limb immediately above the seat of an arterial hremorrhaO'e and pulled tight will arrest bleeding. The form of ihis bandage is a strip of elastic wcbbmg twenty-five or thirty inches long and two inches -wide, with a piece of tape sewn at each end. An elastic brace or belt will, however, answer the purpose. It is not advisable to use a cord or elastic bandage unless no other apparatus can be had, as the pressure of the cord cuts off all circulation in the limb.

III. Flexion of the Limb.-The arteries at the back of the knee and the front of the bend of the elbow may be compressed by placing a pad upon the trunk of the artery at the knee or elbow, and, after fully flexmg the limb, securing the limb in a flexed position by a bandage.

D1'ess the u;ound. After the hremorrhage has been arrested by the indirect method, the wound must be covered oyer by a clean dressing. (See 'Younds.)

In all ca 'es, especially when the patient has to be moved some distance, the injured limb or part should be . raised, if possible, and maintained at rest by splmts aud bandages, if need be.

TilE COURSE OF THE MAIN ARTEIl1ES A'ND THE AUUEST OF Hj£l\IQRUHAGE.

(See (ron tisp'iece).

The Aorta is the main artery of the body. mencing at the left, ventricle, it forms an arch behmd the upper part of the breast From the arch are given off the large trunks whlCh carry the blood to either side of the head and neck and to the npper extremities. The aorta passes down on left of the spine to just below the navel, .It ends .by dividing into two large branches (the Iha?s) "hlCh con vey the bleod to the organs in the pelVIS, and to the lower extremities.

AUTERIES OF THE HEAD A - D NECK.

The Common Carotid Arteries run up the neck one on either side of the windpipe, and on a level with "Adam's apple," just below the angb of the divide into the internal and external carotids. Internal Carotid passes up deeply in the necK5 anti entering the cranium just internal to the ear supplies the brain \\"ith blood. The External Carotid artery gives off branches to tho tongue, the throat, the face, tho nose, the temple and the sealp.

W OUKDS OF TilE CAnOTID ARTERIES AND THEIR BRANCHES.

When a Carotid artery is wounded , as iv t.ns. case of cut throat, apply digital compression by placing. t?e thumb on the artery by the side of the windpipe, eIther on the wound or between it and the heart, pressing bll,ckwards against the back bone, taking care to avoid the wiEdpipe. Pressure must be maintained by the thumb (by relays of assistants if necessary), until the doetor ani ves; no other method being applicable in this situaLion. Bleeding from the is readily

FIG. 38. arrested by the thumb . on the wound, or by placmg a firm pad on the wonnd, and makilJ0' pressure by a bandag'l npplied as fo11o 'ws :-Apply a pad on the bleeding point, then place the centre of a narrow triangular bandage on {he opposite side of the head to the ,vound, carry the bandage hori, zontally round the head just above the level oj the eyebrows make a twist OTer the pad, pass the ends G2

rounel the head again, or carry one end o:er the top of the heael and the other under tbe chm, and tie firmly (Fig. 39). Hoomorrhage from the Forehead, or from any part of the Scal p, can be arrested on the same p rinci pIe. I-hemorrhage from the Tongue is usually controlled by Sllcking ice; should ice be unsuccessful or unoiJtuin able, and the wound far forw:1rd, the 1leeding point may .. between the fh)O'cr ":-,md thumb. Hwmorrh;n'e from the Lips may be controlled by 'ice, or) if very severe, by compressing the bleeding poilJt bet\yeen the fi n n'e r and th Ul''.J b. H n;morrh;ge from the Cheek is controlled by passing the foreFIG. 39. finger inside the cheek and the thumb outside, and compress ina fi :mly eilhOt· on the wound 0)' llelow it, i.e. \vounel and the heart. The trunk of the FacIal Artery may be compressed on. the edge of the lower jaw, about an inch and a-half l1l front, of the angle. " Then the bleeding is from the To,nsll., Palate, or the inside cf the Throat, glve lee to suck., f the h<:el110rrhage is severe it may be necessary to

compress the carotid in the ned:. Hoomorrhage from. the Nose is treated as fo11o\\"s :-Seat the p:1tient on a chair with the head slightly thrown b:1ck; undo alJ tight clothing round th che t and neck; raise the. hands aboye the head apply cold (ice, a cold sponge, or a bunch of keys / over the spine at the lowl of the collar; keep til patient in a current of ail', and on no acconnt allolY him to hang his head fo·r ward oyer a basin; pl.-wo the fcet in hot watcr. Blood i uing from th e Ear channel, which genel'<llIy indicate'S a fractnre of the FIG. 40. uase of the cranium, must,

ARRF.ST OF H I£1I10RRIUGE be wipeJ away as it issues ; FRO1\! FOREHEAD. no is to be made to plug the ear. 'When the external part of the ?::H itself is wounded ar:;:: b1eeels freely, grasp the bleedmg point between the finger and thumb.

ARTERIES OF TilE IT PPEU EXTRDIITIES.

r-fhe S llbclavian artery passes from behind the inner end of the collar-bone across the first nh

to gain the armpit (axilla). In the armpit the Axillary artery, which is a continuation of the s ubclavian, keeps clor:e to the shoulder joint, and can be felt pulsating when the fingers are deeply pressed into the armpit. The Brachial artery is a continuation the axillary, and runs down tbe arm on the inner side of the biceps muscle, gr!1dually passing forwards until it gains the middle of the front of the elbow. The inller seam of the coat sleeve above the e;bow roug'hly indicates its conI' e. Just below the el bJW the braehial artery divides into the radial and ulnar arteries. The Radial artery runs along the onter side of the front of the forearm; its course be indicated by a line drawn from the middle of the bend of the ell.>ow ill front to the root of the of the thumb. About one inch abo \'e tlle wrist, and one-half inch from the onter (thumb or radial) side of the forearm; where the radial artery lies upon the radius, the pulse is to be felt. The radial artery, at the wrist, turns backwards abo\'e the root of the thumb to the back of the hand, and pa::;ses fonYard bet,;"een the metacarpal bones of the thumb and forefinger to reach th(; palm of the hand The Ulnar artery runs along the front of t he forearm, corresponding to a line drawn from the centre of the £i'ont of the elbow to the root of th e b:111 of the Jittle finger. III the hand the branches of the radial and ulnar arteries

87

combine to form the ,superficial and deep Palmar arches. The superficlal Palmar arch is near the surface of the palm, and corresponds to the line that runs along the inner side of the ball of the thumb. The deep Palmar arch is slightly nearer the wrist but deeply on, the In the fingers, artenes run al?ng eIther SIde of the fingers to the tip, where they uOlte.

ARREST OF AUTERIAL HJE)IORllHAGE THE UPPER Lmns.

When a Digital (finger) artery is wounded place the thumb on the bleeding point and compress the part firmly; subsequently, apply a small pad on t?e wound, bandage with a piece of tape, strip of l111en, or a stnp of plaster, round the finger and pad, When the Palmar Arch is wounded , place the le,ft thumb firmly on the bleeding point, le..tving the rIght hand free to apply a pad and bandage, Arply a firm pad (a folded handkerchief), or better stIll, a compress on the bleeding point, make the patient grasp the pad firmly, and apply a bandage as follows :-Spread out a triangular bandage, up the lower border about four inches, lay tne "back of the patient's hand on the centre of the bandage, fold the point over the knuckles and wrist, pass the two ends round the wrist, make the patient

88

pull on the poi!lt of the ?andae;e, cross the ends ?ver the fingers tWlCe and tie them as firmly as possIble. Bring the point (A) down. to the and fasten with a pin at B (see FIg. 41). bend forearm well up and support wIth a large ar lU sling.

FIG. 41.

The Radial and Ulnar arteries may .he compressed by thumbs ?11 the arterles Qne inch above the Wl'lst (FIg. 42). Thls may be neceslSary when the wound in the palm is too large to be covered 'by the thumb: in stead of the cork of a pint or 9 l1art bottle may be cut 111 t.\\ 0

89

lengthwise, and one half laid on the radial, and the other on the ulnar artery a little above the wrist· place the r oun ded sides of the cut cork next skin and secure them by a tight bandage. See also next paragraph.

FIG. 42.

Hrernorrhage from a wound of the Radial or Ulnar artery in theJront of the forearm may be arrested by a pad placed m front of the middle of the clb?w, being firmly flexed on the arm, and mamtall1ed III the flexed position by a bandage. The pad mn.y be made of a folded. handkel'chicf with a

small stone or cork "Tapped up in it; but when no paa if:) avaihble the coat sleeve rollfld or gathered up as far

FIG. 43.

as the elbow will serve as a pad. Bend the forearm upon. the arm and tie a narrow-fold bandage round the wrist and then round the upper part of t!le arm,

91

crossing the ends between the forearm and arm so as to better prevent the bandage slipping off. Finally, tie the limb to the side by a bandage encircling the lim b and the trunk.

Hremorrhage from the hand , forearm , bend of elbow, or lower part of the arm may be arrested by compressiug UlC brachial artery by digital compression or by a tOllrniquet. ·When applying an improvised tourniquet to the brachial artery, it is not always necescary to use the stick j the best plan is to

tie a half-knot and pull tbe bandage tight j if the bleeding stops, complete the reef knot, but if it does llot stop use the stick, as described on page 79.

To apply digital compression to the Brachial artery.-Extend the arm at right angles to the body, palm of the hand upwards. Stand behind the limb, grasp the arm, the thumb on the outside of the limb, and pass the {;.ingers under the Lack

FIC:.44.

of the arm until the seam of the coat, or the groove on the inside of the muscle (biceps) is reached. Press the pulps (not the tips) of the fingers firmly on the course of the artery (see Fig. 44). Some prefer to grasp the arm from above the muscle, but if this course is adopted, great care must be taken to press the artery against the bone,

FIG. 45.

and not against the biceps muscle. A slight turn of the hand outwards as It grasps the arm will better ensure compression 9f the artery. In practice feel the pulse with the free,..hand during attempts at compression of the brachial, to ascertaiu if the Bow of blood along the artery is stopped.

Hcemorrhage from the armpit or arm may be a:-rested by compression of the axillary artery. Roll up a nard pad the size of a billiard ball in a triangular oclndage; place the pad in the armpit; cross the bandage on the shoulder, pull the ends tight, and tie

off under the opposite armpit, taking care that neither the pad nOr bandage has slipped. Secure the injured arm to the patient's side, as shown in Fig. 46.

. f the Subclavian

D igital wound in the main artery may be ID;a e w or in the armpit. Proar tery is high up III the k to below the collar ceed as follows :.-:-Barde i. e aga!nst the side of bone, place the lllJure 1m

FIG. 47.

., as to depress the 811On1(1er, and the patlent s bod d y so <;t the -shoulder use the left take your stan oppos, e . '.. the hand for the right. neck lowdown, placmgtthe of the collar-bone in attached to the bone

(the bird's nest); cOQpress firmly, pressing the thumb deeply downwards and backwards against the first rib, which is beneath the clavicle at this spot. In practice the pulse may be felt at the same time to ascertain if the flow is stopped. (Fig. 47.)

Y\fOUNDS OF TilE LARGE ARTERIES WITIIIX THE CrmST OR ABDOMEN:

(IXTERKAL HlEMORRHAGE.)

Wounds of the large arteries within the trunk cause hremorrhage into the cavity of the chest o.r of the abdomen: and giYe rise to signs and symptoms of internal hremorrhagc.

Signs and Symptoms oj Inil1'nal Hcemorrhage are:

- A rapid loss of strength ; pallor of the face and lips; coldness of the ex tremities, giddiness and fain tness, more especially when the upright position is assumed; the breathing becomes hurried and laboured, and is accompanied by yawning and sighing; the pulse Jail:; gradually and may altogether disappear at the wrist; the pabent throws his arms about., tugs at tlw clothing round the neck and calls for air. Fillally, tLe patient may become totally unconsciom:.

TTeatmeni oj I nternal Hromorrhage.-Keepthe patient flat; nndo all tight clothing round the neck; provide for free circulation of air; fall thE:; patient; sprinkle

cold water on the face; apply smelling to nostrils' give ice to suck or cold water to the feet a foot or two from the ground, an the limbs firmly from the feet to, the, hlpS a.l:d, hom the hands to the shoulders. Avoul sh!mdants, lU cases of hremorrha.ge, a.t a.ll events until bleedmg u.s been controlled.

THE COURSE OF TilE ARTERIES IN THE LOWE1.\. EXTREMITIES.

The Femoral artery, u. continuation of the iliac enters the '!thigh in the centre of the f?ld of the groin where it ma.y be felt pulsat.ll1g , d' t 1 below the skin The course of tlu' llllme ia e Y . l' 1 f om the artery ma.)' be indica.ted by a me (mwn r . centre of the groin to the back l?art of the lOner side of the knee. The a.rtery occup- es only the upper two-thirds of this line, as at the lower part of the thigh the femoral artery passes to ba.ck of the knee joint e.nder the name of the pophteal.

The popliteal artery -the artery of the ham -occupies the centre of the space at the back of the knee (the ham.) It is placed deeply the projections vf bone at the lower end of t e femur, and is further pro"_Jcted by the muscl.es and tendons around the ham. Just below a.nc1 behllld the 97

knee join t the popliteal a.rtery divides into the anterior (front) and posterior (back) tibial arteries.

The Posterior Tibial artery passes down the cen tre of the back of the leg to the inner side of the ankle, where, between the heel and the lower end of the Tibia, it enters the sole of the foot as the Plantar arteries. In the upper pa.rt of the leg the posterior tibial artery is deeply placed beneath the muscles of the calf, but towa.rds the ankle it comes nearer the surface. and can be felt pulsating in the hollow on the inner sid9 of the ankle. In the sole of the foot tlle Plantar arteries run forwards amongst the muscles to supply tbe foot and the toes.

The Anterior Tibial artery comes from the PQplitea.l and at once passes forwards between the leg bone. The artery runs down the front of the leg, deeply placed amongst the muscles, to the front of the a.nkle. A line drawn from the front of the upper end (head) of the fibula to thG centre of the front of the ankle indicate3 the course of the artery.

The Dorsal artery of the foot is the continuation of the anterio: tibial artery j it passes along a line drawn from the mIddle of the front of the ankle to the interval between the metatarsal bones of the biotoe and the next, where it passes downwards to sole of the foot, to form au arch with the artories of the sole.

H

ARREST OF ARTERIAL H2EMORRHA<:iE IN THE LOWER EXTREMITIES .

1 When the arteries in the SOtlh e e . t wounded remove fJf F 00 lar:h left thumb firmly on the bleeding 3tockmg; app e 'io.ht hand prepare and place point· and, wIth the 1 0 . 'htl . An expea pad 'on the wOlU1.d, ant secure the rienced person mlght e a e f nads tightly fl' 'hage by means 0 t" 1 arrest 0 lremoll h kl at the points indicatcCl bandagcd, placed on t e an e ill the frontispiece.

FIG.48.

h arteries of the Ham or of When t e ded or when a pad is 'the Le.g are from the insufficIent to arres d th . of an orange foot or ankle, place a pa e 'Ize

99

behind the knee of the injured limb; flex the leg upon. the thigh until the heel almost touches the buttock; secure the limb in the flexed position by passing a narrow bandage (or a strap) round tho leg immediately above the ankle; cross the ends between the leg and thigh, and, carrying them round the limb close to the top of the thigh , tie them off firmly. 'When no pad is to be had, roll up the trouser lcg as far as the knee, and flex the leg on that as a )ac1. It is not necessary to take off the clothin g tu compress the popliteal artery by a pad and flexion. Except at the lower third of the leg, it is seldom possible by direct pressure on the bleeding point to arrest hremorrhage from the arteries of the leg.

3. 'When the femcral artery in the lower half of lts course is wounded, and when a pad and flexion fail to control hremorrhage from the popliteal or tibial arteries, apply digital compression to the femoral artery at the groin, until a tourniquet can be applied . To apply Digital Compression to the Femoral artery at the GrGin.-Supposing it is the right femoral that is to be compressed, proceed as follows :-Lay the patient do,Yn flat on the back; stand or kneel as convenient on the left side of the patient's body; to find the groin, raise the foot b;gn so as to flex the thigh on the body (the fold in the clothing at the top of the thigh will inuicate the groin); pass the fingers of the ri ght hand o,er the 11 2

100

.outer sid.e of the right hip just below the edge of the front part of the haunch bone, and by the fleshy part of the thumb fiat on the centre of t.he groin. r<1SS the {ingers of the left hand to the inner sirle of the right thigh close up to the fork, and 13,y the left. thumb on the top of the right thumh ,g,1rea\1y ill po!:)ition over the artery. Press firmly

FIG. 49.

b::I.Cb. wards agn,inst the brim of the pelvis, when the flow of b100d will be completely arrested. As death is imminent ill hoomorrhag e from so large arteries, it is important not to waste time removing the clothing; the femoral artery at the groin can in men be compressed as a t em pontry measure over the clothing.

To apply a Tourniquet to the Femoral artery.-In practice it is a good plan to mark the

101

course of the artery b d . centre of th . Y rawmg a chalk line from the of the kneee . to tthe back part of t.he inner side ) 1e ar er! . can be compressed by a to.mmquet at any point on the third of the line tlllJ8 or a little high er. An a field, or a screw tournIquet may be used. Tb Dad of th" e e Improvlbecl tourniquet should ber vlS Jarge as half orange; a narrmy bal ld agc IS to be placed WIth its centre over the pad, the knot tied on the outside oj' the thiah' the " stick" . t b 0' IS 0 e placed bet,Ycen the "})'11"c' I, f t1 Ii: .' .. ::;. 0 1e n.ot, so as to aVOId lllJurin o' th skm when it it) twisted. F' b 11 e the " t' 1 " . llla y, s Ie (, 1::) to 1 e "lock d 11 u:ld the. Jimb put ill a ",plin:

FIG. 50. tIed to Its fellow.

wounded in the 4. Whep the artery is femoral artery must thlrdd of t.he thigh the at the groil) in 'tead by the thumbs Relays of must a, tourniquet. the pressure until tl d e o)'ed t o keep up assistant applvinO' hi"le tl octoll arrlYCS, the freRh J b '" lUlll JS on tb ose of the

previous assistant, who careblly slips his thumbs fr om beeeath, so as to prevent gushes of blood dlll'ing the changes. " Then assistants are few, or a doctor not t o be h ad, an attempt may be made to anest the h mmo rrh age by placing a pad on the centre of the groin, and maintaining pressure by an elastic cord passed from the back of the thigh, crossed over the pad, and the ends fastened behind over the loins.

YEXOUS H,DIORnilAGE.

Tho CUlTellt of in tho veins is in a direction to"':1.nl::; the heart, thcrefore, 'when a vein is cut the t,lood will issue from the end of the wounded vein furthest removed from the heart. The reason why the cnd nearer the heart dves not bleed is explained lKl.rtly by the direction of the flo.\\' of the blood, and plltly by tbe valves in the vein} which are so placed a') to pre rent a backward flow. The superficial veins are mor e apt to be wounded than are the deep veins.

TnEA.T:JfExT OF YEXOUS HiEUORRHAGE.

(1) Lay the patient down, the head resting on a low snpport or pillo\\'.

(2) Should it be a vein in one of the extremities that is bleeding, elevate the limb.

(3) Undo the c10tning and expose tha bleeding ps.rt.

(4) Apply direct pressure on the wound by the thumb, and maintain the pressure subsequently by a pad and bandage.

(5) Should direct pressure prove insufficient, apply pad and bandage on the trunk of the vein , on the side of wound furthest fr om the heart.

Varicose Veins. - The veins of the legs are specially apt to become varicose. 'Yhen the vari cose vein is examined, it will be seen not only to be dilated and tortuous, bllt bead-like (varicose) projections occur along its course. A vein becomes varicose from various causes, such as long standing, tight garters, etc., etc. The fin;t effect is to throw extra work upon the valves, and the bead-like projections are caused by the blood accumulating in the pockets behind the valves. In tirrle, the channel of the vein becomes so wide that the valves can no longer span the vessel 'When one of the e dilated veins, say, in the leg, is wounded or bur8ts, blood flows from the lower end of the cut vein, but from the end nearer the heart it flows in much larger amount, owinO' to the imperfect state of the valves in the veins. b

.. Treairneni.-,When hremorrhage o()c urs from a varicose vein in the leg the treatment is to-

(1) Lay the patient fiat, the h ead restin g on a low support or pillow.

2) Elevate the limb, raising it high, at a right angle to the body if necessary.

(3) Remo v e the clo t hing so as to expose the bleeding part.

(4) Apply d irect pressure on t h e wound by the thumb, and subsequently by a pad and bandage.

(5 ) Apply bandages from both and the wound should the direct pressure prove msufficlent.

TREATlIIEXT OF CAPILLARY H lElIlORRHAGE.

(See also Treatment of Wounds, page 124.)

To arrest hromorrhage from capillaries, a slight degree of pressure suffices. P ressure be applied instantaneously by the thumb, and mamtamed subsequently by a pad or pledget of lint. may also be exercised by applymg a pIece of strappmg (plaster) to the wound over a pad. Any which aids in the arrest of hoomorrhage IS termed a Styptic . Cold, as cold air or ice, arrests hoomorrhage by contracting the blood vessels . Water as hot as can be borne, by causing the blood to clot, may check capillary hoomorrhage.

Such remedies as fine strands of wool, or cottO]) wool, coarse blotting paper, etc., etc., have, if .clean, to recommend them. Collodion applIed on a fine web of cotton wool is an efficient styptic.

105 CHArTER III.

THE NERVOUS SYSTEM.

Two systems of nerves, the Cerebro-spinal and the Sympathetic; preside over the movements and fUllctions of the body.

The Cerebro-Spinal system is made up of the Brain, the Spinal Cord, and the Terves.

The Brain is situated within the cranium and is divided in the middle line, so that, with the of a few connecting bands, the right and left sides are separate.

The Spinal Cord is the long cord of nervous matter lying within the spinal canal in the bony :l.l'cb formed the vertebrCB (see Vertebral Column) It leaves 'J.le brain case through the base of the ')kull, and reaches as low as the upper lumbar vcrtebr::e erves proceed from the brain and -pinal cord m pall'S, the former are termed the cranial, the latter the spinal A pair of spinal nerves emerges between each of the vertebr oo. The ne r ves cross the about its base, and ill the spinal cord; so that the nght half of the brain presides over ·- he left half of the body and limbs, and t he left half over the r ight side of the body and limbs. In the limbs and trunk the n er ves are met with as large pearl y

107

whi te trunks, and can be traced to the muscles and skin.

To illustrate the course and functions of nerves, the following object lesson will suffice:--When the skin of, say the foot, is tickled or injured, the sensation tra-: -els by one set of nerves up I. he lower limb to the spi al cord, and thence to t}- e brain. These ner"'18S ) 'vecause they carry tile .,ensation from the skin to the brain, are named the sensm·y nerves. The brain now decides what is to be done with the foot that is injured or tickled. It sends its message down the spinal cord and out FIG. 51.

DIAGRAM SHOWING THE BRATN AND THE SPINAL CORD, WITH THE N.I!.RVES OF THE LEFT SIDE OF THE BODY.

by another set of nerves to the muscles of the lo\;o,'er limb, and the part is moved away, rubbed, etc., etc. The nerves performing this functIOn are the moto?" nerves, because they go to the muscles, which bring abo ut the necessary movements. Motor nerves and sensory nerves travel together in th.e s.ame trunks. One of the best known nerves is the sClatlC nerve (hence the term sciatica), which runs down .the back of the thigh, and di viding into branches supplIes the muscles and skin of the lower limb.

The Sympathetic System of nerves consists of a double chain of nerves and small nervous masses Wtnglia) on either side of the front of the spmal column. The chain ex:tends from the base of the .skull to the coccyx. The nerves of the sympathetIc system send branches to all the organs of the ches.t and abdomen. It is this system that controls the lllvoluntary muscles of the bodv· it reo'ulates all our vital functions .as well as the°snpply of blood to the secretll1g and excreting organs. The system from the cerebo-spinal system, ll1asmuch as It acts during sleep, and knows no prolonged rest.

INSENSIBIL TTY.

or insensibility arises when fnllctlOns. the br:-tin are in abeyance, ei tIler dIrectly from ll1Jury or disease of the brain it!:ielf or ,

]08

from disturbance of the action. of the lungs or heart.

UEN2RAL OF INSENSIBILITY.

W HEN A PERSON IS FOUND IN A STATE OF :

1. Arrest hremorrhage, if present. Lay the person on the bac k, or in the position in which breathing is most easy.

3. Undo all tight clothing round the neck, ehest, and waist, unfastening the braces and top button of the trousers in men, and the corsets in wome n .

4. Provide for a sufficiency of fr e s h ai r by keeping the crowd away if in the street, or by opening the doors and windows if the accident has occurred indoors.

5. Obtain a docto r' s help at once j as a general rule, until he arrives, k eep the head low if the face is pale, and raise it somewhat if the face is flushed.

6. Never leave the paticnt until you have placed him in charge of a responsible person.

N.B. Give no food or fluids (neither stimulants, tea, water, nor medicin es) by the mouth while the patient is insensi ble.

THEN PROCEED TO EX-UllNE THE PERSON AS INDIC <\.TED BELOW, TO LEARN THE NATURE OF THE \ 1. Feel if the pul e beats at the wrist (radial artery), at the temple (temporal artery) , or in the neck (carotid artery). The p ulse may be absent, or . 109

it .may be unnatu.rally slo:v, quick, or feeble ; it may nuss a beat (mtermittent pulse) ; or, the may beat qmckly and . (Ill.egular. pul.se ). All these COi1dIbons mdleate some mIschIef wilen associated with insensibility.

.;;. If the pulse cannot be felt pla0e the hand over heart, or apply the ear to the chest, to ascertain If the heart beat'3 .

3. Observe if the person breathes, and note the odour of the breath. The breathinO' may be slow htboured, and accompanied by loud sn01'1nO' and of the checks during expiration ll/'eathmg).

4. the scalp, temples and back of the head for ll1Jury; the ears and the nose for 'iO'IlS of hremorrhage; and the. mouth for blood froth L 'd ' ,,,,, uyaCl s, etc., and for foreign bodies.

5.. Raise the eyelid.:;, and examine the state of the pup tIs.

The pupils are the dark round spots in the centre of brown, ?r grey iris. Under ordinary c.ondltIOns 1ll lIght the pupils dilate, in briO'ht they contract to small dimensions. In dlfle!1sed the pupils are altered, they may be both l.mclely or both minutely contracted, or, Oll the other hand, they may be unequal or irreo·ulu.rthat is, one may be and th e other s7nall. E:ery one of snch altered condItIOns denotes a serious state. The

HI

pupils are said to be fixed when in either a shadec"l or a brigbt light no alteration takes place in their size.

6. Examine the body and extremities for signs of fractures, dislocations, wounds- the neck for signs of strangulation or banging-and compare the two sides of the body as to limpness or helplessness .

7. Notice the temperature of tbe skin, whether it be natural, hot, or cold. The quickest way of doing this is to place the back of the hand on the naked chest of the patient.

SHOCK LEADIKG TO COLT,APSE FROM IKJURY).

After every accident of any severity the patient suffers from sbock. It is not so much a m ental condition that results, as one dependent upon the physical consequences of injury.

Signs and Symptorns.-The patient complains of feeling cold and may a,ctually shiver with cold. Thefac'e is pale, the skin is cold and clammy, the pulse is weak, tile breathing is scarcely perceptible, and the temperature of the body, if taken by a thermometer, will b'e found L,O be belQw the normal (98'4). In very severe injuries such as extensive burns, broken bones, lacerated wounds, or severe crush with deep -seated inj uries, the temperature may fall to 94 degrees or eyen lower ;

in cases. recovery is rendered doubtful. The meantIme may remains oonscious, but appears !n some cases of shock the patient ma k€e qUIte qmet, but in. other cases a marked, prevaIls. The patient may become deliowmg to severe pain, loss of blood or mental Isturbance, or may collapse from loss of blood, or the severity of the shock.the temperatnre fallin rr b covermg. the patIent up with a coat, &hawl, bla'='nke[ or at hand. As soon as possible get th; patIent under cover in a warm room or in bed d promote warmth by hot flannels, bottles feet and abdomen a d 'f th " e . . ' n, I e patIent IS not unconSCIOUS., gIve warm drinks, tea, hot milk, etc. ,Vhen hot bottles see that they are wrapped up III a of. or cloth of some kind to prevent possIble mJury to the skin.

COXCUSSIOX OF THE BRAIN.

..When cranium is struck a severe blow or dUrIng a fall, the brain may be concussedthat IS, the person may be stunned. There may be no of the scalp or injury to the bone, but the b:am IS so shaken that for the time bein it is func.tIOl1less or paralysed. g

S1,gns and a feeble pulse, shallow breathmg, the pupils fixed, and generally

equal in size. History of a fall or a severe blow may be obtained; or injury to the head may be evidenced by wounds, bruises, &c.

Treatment.-Treat the patient as directed for Insensibility; attending to the position of the patient, loosening the clothing, and seeing to the admission of fresh air, without anything being gi\en by the mouth. The patient in slight cases recovers consciousness in a few minutes, but in seyere cases he mn.y remain insensible for one hour 0 ,1' more. Vomit· ing usually occurs as the patient is coming round. Send at once for a doctor.

COMPRESSION OF THE

'Yhen from a fall or blow the cranium is fractured, and a piece of bone driven in wards, the brain mn.y be compressed. On the other hand. the broken bone may injure 3 l)lood-vessel within tbA cranium, and compression may result from. pr:ssure of blood on the brain. In the former case the Insensibility will come on immediately; in the latter, after some minutes, possibly 15 or 20, that is, when the blood has accumulated in sufficient quantity to exer· cise pressure on the brain.

Signs and evidence of a wound of the scalp; the fracture of a cranial bone may be felt; a slow, full pulse j breathing;

113

unequal fix ed when the pressu re IS In InjurIes to the brain symptoms of concu " 8IOn may: first prevail, succeeded o.y symptoms of compressIOn.

Ge?eral treatment for insensibility

(plaCIng the patIent In an easy po::;itiol1 to orcathe tight and securing a sufficiency of !resh aIr). (2) Rmse the head slightly . (3) .Apply Ice or cold-water cloths. to the head. (4:) Do not attempt to rouse the patIent or to giYe anything by the mouth. (5) ,\Y.hen conveyed to shelter, to his home, or to a hospItal, leaye him undisturbed until the doctor ani \'es.

APOPLEXY.

a blood-vessel gives way within the the bram IS and its ti::;sne partly destlO.yed by the blood w1Ich escapes. ,YhCll the of blood is large the symptoms develop so rapId.ly that the condition is termed an apoplectic fit or SeIzure.

Signs and a full, slow pulse, stertorous breathmg, unequal (o11e large an d small) and fixed pupils, a flnshed face, a hot skin temperature. of the body is usually markedly and the lImbs of one side. 0,£ .the body lin'lp. on the other, the normal ng!chty rna}' be 1'0 tamed-are the indications of a severe npoplecti{'

. f the atient is a help in recognising attack. The age? p lly elderly people are the condition, as It IS nsua seized. (1) G "al treatment for insensibility

T1'eatm ent.- . enC! d ' eck chest and abdo(loosen the clothmg roun n h 'f ..) '('Y) Lay the . 1 f f· e dr"u o' t 0 all. .;.J

j provh C a. k1ewith LO the head slightly raised. patIent on the ac ( ) A 1 cold to the head, (3 Get a d oc tor at once. 4: pp Y t f cold

) < • b 0' r by cloths wrung ou 0 either bY,...an 2ce - :1°h of et warm by hot water bottles, water. (;» I eep tee st'1rd laster. N.B. - Premustard l ea \'eb, ?l' a . ffiU, be mouth 'rake care -tl . 10' ly,tn CY gIven y . l' vent an) III b v 0.. 1 b the hot-wa.ter bott os , that the skin i8not Yfeeling them with the t h Olwht to be y fl 1 tc ey "h 1, ' 1 and then wrapped in anne, e ., bnck of t e Ll ) ( , < 'k before phcing tltem <1gamst tho S 111.

C OLLAPSE FROM DRINK.

d -ink is generally witnesscd "Physi.cal collapse from r hom from wallt of . persons upon w , in very poor. ffi" t clothinO', etc., drink (it may nourishment, lUSU Cle.n h anb undue effect. It is be even a small quantIty) as h sically collapsedseldom that drunkards become PI y d L t the circutheir mental powers mal para !s:' u , f h blood rctams Its power. lablOn 0 tel 'bTty m'1Y be c.om.

Signs and Symptoms.-; eithe; capable of Plete or partial, the pl1 lcn .0 , The pulse is . . . d or tOh.lly nnconsclOl.S. 'clng rO ll:Se ,

feeble or completely absent at the wrist; the breathing is slow, and perhaps slightly stertorous; the breath smells of drink j the pupils are dilated, equal, and re pond to light j the face is pale, and the surface of the skin cold and clammy.

N.B.-It must not be assumed that a person collap ed from drink m erely because the b12ath smells of drink j frequently, \\'hen people are feelinci ill, th ey take 01' are given stimulants, after which they may become insensible, not from the drink but from the cause \rhich induced them to take it, e.g., apoplexy coming o. effects of poisoning., etc., etc.

'l'J'eatm e71t..-(I) General treatment for insensibility (loosen clothing, provide free circulation of air, and place in position in whi ch breathing is possible). (2) Keep the patient warm by covering him over or t:lking him indoors, and applying hot-water bottles and friction to the surface, more especially to the limbs. (3) When the patient can be roused give warm tea or coffee. (4) vVhen the pulse is res tored give an emetic of a dessert-spoonful of mustard in a tumblerful of luke-warm ,rater. (5) When the emetic has effected its purpose, support the patient's strength by giving tea, beef tea, brandy in small quantity, or by any of tile prepared foods, soups, or essences.

The apoplectic stato and collapse from drink are nob mistaken tha ona for the other.

The more prominent means of distinguishing them are as follows:- tt' 'n

1. In apoplexy the patient is usually, ge on I f years; collapse from drink may occur m n. peIson 0 absence of the smell of drink would indicate generally unequal, and in equal and responding to hght m collapse

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streets, J.t public meetings, ill a public conveyance-in fact, anywhere. Owing to its sudden development the patient may incur serious danger, especially when the attack comes on near a fire, machinery, a steep bank or precipice, or where traffic is great.

dri;k The pulse at the wrist in is usually and full; in collapse fro. , drink It IS feeble or altogether absent.

1 t d

5 The features in apoplexy are usual y conges e l and' suffused; in collapse from drink they are pa e and pinched, , . t

6 Should means of ascertammg the ure be hand, it will be found in apoplexy above, and in collapse from drink conslderab y e ow the normal (98.4).

EPILEPSY.

This disease is frequently termed .,the "fallin!

. k "It occurs in persons of alJ ost any ag , SIC ness. ..' a adults but most frequently It IS seen m yount? . It is a common form of "fit," .and as It with but little if any warnmg, the may take place by nigr.t or day, at home, m the

Signs and Symptoms.-Sometimes with, but generally without, a scream the patieut falls to the ground, insensible. The muscles of the body are in a state of spasm, so that the features are distorted, the hands are tightly clenched with the thumbs inwards. Very quickly, the rigid spasm by whi:lh all these parts have been fixed is exchanged for a state of convulsion, during which the face, limbs and body are Tiolently contorted. The eyes may squint, the pupil are equal, dilated, and fixed. The face at first pale, becomes dusky, and froth frequently appears at the mouth and occasionally at the nostrils. The tongue is apt to be bitten, and when it is the froth from the mouth may be tinged with blood.

The duration of an epileptic fit is uncertain; it may continue for but a minute or two, or for five to fifteet minutes. ,Vhen the fit ceases the patient may recover completely, may fall into a deep sleep, or may have a succession of similar fits, .,Treatment. -(1) General treatment for insensibility (loosen clothing, allow free circulation of air, attend to position). (2) Prevent the patient from hurting him. self as he falls and after he has fallen. (3) During

the fit drag him away from a wall, heav'y p-iece of furniture, or other source of danger not easIly moved; push lighter furniture out of the way. Kneel down beside the patient and support .hls head. (5) Wrap a piece of wood or any (handle of pocket knife, indiarubber, pencIl, etc.) m a handkerchief, and hold it between the teeth to prevent the tongue being bitten. N.B. The movement of the !imbs must be restrained but not altogether prevented or completely checked, aR during the spasms the muscles miO'ht be torn. Give nothing by the mouth. (6) After the fit see that the patient is cared for by friends or conveyed to shelter, and allowed to rest and sleep.

FAIKTING (SYKCOPE).

Cause.-A close or crowded room, tight clothing, fright, sudden bad news, fatigue, want of food, loss of blood, heart failure, etc. .' .

Signs and Sympfoms.-Pallor, a feelmg of a feeble pulse, shallow breathing, blurred "VISIon, followed by insensibility more or less . ..

T,.eatment.-(l) General of .1l1senslblhty (loosen clothing, provid.e circulatIOn of alr, attend to position ). (2) Lay the patient on the floor, on a couch or on the ground, or, If possIble, as when the patient is a form, let the head drop over the edge of the form a little below the level of .the body. (3) Raise the feet a little. Get as much aIr to play

!J9

t?e patient as possible by creating a draught, by la.nnm.g, etc. (4) Smelling salts held to the WIll aId recovery. (5) 'When sensibility is restored remove the patient into the open air, but should rec?v,ery be delayed for several minutes after t he flat has been aS8umed, the patient must be carried whIlst yet insensible to the open air.

Nofe.- If bleeding is the canse of the faint, arrest the befo:-e treating the insensibility. If patIent IS suffermg from want of nourishment, gIve food sparingly at first.

HYSTERICAL FITS (HYSTERIA).

. and Symptoms. - The lXLtient: usuall y a young glrl, m consequence of some mental excitement, sud . denl.y loses command of her feelings and actions, she sllby\des on a couch in some comfortable po.<;ition, and commen?es herself about, grinding her teeth, clenchmg her fists, shakinO' her hair loose now at anything or neal' her, klCkmg, or laughing. The eyeballs m:q be t urned and the eyelids opened and rapidly. At a froth may appear at the lip and sc\'cral other Irregular symptoms develop. The patient is not completely insensibl e in J'lystcria.

firml'y to the patient; threate n ;;lth cold wate:- douche, and, if she persists in her . fit, sprlllkle her WIth cold water. Medical treatment

d· . iI:!'

Ill!Ct':::: .J<'U·V to cnre the patient of, the can ItlOn mind and body ,\'hich gives rise to the tendency to hysterical attacks.

Heat Stroke and Heat Apoplexy are terms also applied to this condition. " ". is usually applied to that form or the alIment whlCh comes on sllddenl v whilst exposed to great heat; and " heat-stroke" is "the term used when the symptoms appear after the sun ha,s. set, in conseq nence of to SGvere heat dllrmg day.

Si'.fl1s and S!Jmptoms.- WhIlst exposed to great neat, n,s in the engine-room or stoke-hole on ,board steamers, especially in the tropics, or dunng a march \yhibt heavily burdened in very hot ,:eather, arsons so situated may develop a sudden SIckness, :. feelin o' of faintness, giddiness, and difficulty in

The patient complains of thirst, the skin becomes dry and burning, the faee con.gested,'. pulse quick and bouncling. Final,ly, ll1sensIblllty may result, with stertorous breathmg, followed by collapse. .' "

Trea:tment.-Undo all tIght clothll1g; remove the }Jatient to a cool, shady spot-if on boa.rd ship,between decks; if in the open, to the shade; If near a ?ouse, carry him indoors and darken the room: the paticn t to the waist, procure as free a O11'cula tlOn of

possible ?y fanning vigorously, by orening

. Ie COOl' and if in the house, or placing III drau?hty place If on board ship. Keep the patient !ymg down, but WIth the head and shoulders well raIsed on a pillow or folded coat. Pour cold on ,the neck and body, jugful after Jugful, untIl conSCluusness returns. An ice-baO' to the and spille or cold water applications b8 eontmued for s.ome hours. The patient may have cold water to drmk when conscious, but no stimulant

ELECTRIC SnOCK.

Th:'ough ?ontact with an electric wire or other electl'l? the shock may be so severe as to canse msenslbIlrty.

. T?'eatment.-(l) Remove the patient from contact the electric medium. The pers r)l1 assisting the patIent be careful not to touch him whilst III contact With the electricity unless his o\>"n hand a:t: protected, otherwise he will receive the shock hands must be covered by some insulatlDlS such as India-rubber gloves, or a piece of mackIntosh con,t or sheeting; an indiarubber pouch or pouches would serve to protect the hands :n an emerg'ency. If no means whatever of protectlllg the are available, the person. assist may, bnt not \\'1.thout some pn11 the patient away by the cIothmg. The rIsk -:"-ould be greater

if the clothing weTe clamp. Special care must be taken not to touch tbc patient's armpits. Genera.l treatment for insensibility (loosen clothing, procure free circulation of air, and plac@ in reclining position).

(3) Dip a towel in cold water, and attempt to rouse the patient by sharply flicking the face and chest.

(4) Commence artificial respiration (see page 141) if other measures fail to restore animation. (5 ) Treat burns if there are any (see page 130).

EFFECTS OF LIGH'rNING.

A person struck by 1ightning is usually more or less deprived of consciousness. The treatment is the same as that for electric shock, except, of course, that the instructions for removing the patient from contact with the electric medium do not apply.

CO:\VULSIONS CHILDREX.

Teething or stomach troubles are the commonest causes of convuhiions in infants.

SirIns and Svmptoms.-Spasm of the muscles of the limbs and trunk, lividity ef the face, insensibiJity, occasionally squinting, suspended respiration, and frequently freth at the mouth.

the child in a warm bath n.bout the normal temperature of the body (98 degrees 1"ahr.), so that the water reache3 as high as the middle of the t,unk; and place a fponge diPFed in cold water on the top or t.he he::ld.

J23

CHAPTER IV.

WOUNDS INJUIUES OF THE

T!le Skin ser,cs as a protectIve covering to the body, as a g1a.nd for the excretion of perspiration, and as n. means of regulating the heat of the body. 'fhe scarf lUll is composed of l:ard, hOl'lJ .Y cellR; true skill beneath is lich m blood -resseb, and cOlltuins the of the hair, thc oil and sweat glands am1 I)crrcs.

Fig. 52.

MAGNIFIED of BRUISES.

SKIN :-

1 and 2, Scarf Skin A blow anywhere on the 3, True Skin,' f 4, End of Nerve sur ace of the body may cause 5, Sweat GlandandDuct extensive hremorrhaf!e bcJow 6, Root of Hair 'the skin, " 'ithont the skin

7, Oil (Hair) Glan'd. bei1Jg wounded. A -::;;." black cv' eye" isan injurY0f this nature and Symptoms.-The injured part is at first red ened by the blow, but the (:olour quickly assumes a 1 usky hue and then becomes purple and afterwards a most black I f d 1 ' • n a cw aYG t 1e colour apIJcars of a.

125

lighter tint, and after passing throu.gh purple and violet shades, It changes to a greemsh colour and then to a yellow tinge before the normal colour of the skin is attained. . .

Treat?nent.-Beyond the immediate apphcatlOn of lce or cold-water dressings, no " first aid" treatment is required. The virtue to raw meat applied to a black eye f as .no foundatlOn beyond the fact that the piece of meat IS cold.

WOUXDS.

A surface wound may be defined as an injury invol ving an opening in the skin.

TREATMF -T OF V\TOUKDS IN GEKERAL.

Be sure that your Hands are quite Clean .

1. Arrest Hremorrhage at once when the source can be ascertained. When internal hremor· rhage is suspected. the to are :Rest free circulatlOn of all', loosenmg clothmg, and free' use of ice to suck; an ice-bag may also be applied externally in the neighbourhood of the wound.

2. Cleanse and Dress the Wound -(A .) When out-oJ-doors it is but seldom that appropriate mear:s of cleaning a wound are at hand. (a) If no water IS. at hand and but one clean handkerchief is to be had, wIpe the ;ound if it is dirt.y, with a corner of the handkerchiE''. t.hen' fold the handkerr>."hi.ef and tie it over the

wound. If. the handkerchief is soiled apply a piece of clean (unprmted) as the inside of an envelope, on the and tIe a handkerchief, necktie, 01 brace l.t. (b) If clean water is near by, and the wound IS dIrty, but not otherwise, '''ash the " 'o lmd freely, dip (or wash if n ecessary) the handkerchief in the water and apply over the wound.

(B.) Wh en in-doors clean Be th e 1cGund with water that has been boiled and allowed to cool. To the water might be added, in the followinO' proportions if at hand, a few crystals of of potasb to a half tumbler of ",nter; boracic-acid (a teaspoonful of the po.w.der to a of water); or any of the dlt:'ll1fectant 10tlOns 111 common nse. The parts. aro1l.nd the wonnd are to be cleansed by washmg. WIth soap and water. 'Yhen the part bns been .dl'led, cleanliness will be ensured by moppll1g the skll1 around the wound with spirits of wine or with whisky. D1-ess th e u·oul1d.-The wound may now "?e dressed by one of the following methods: -(a) A pIece of dry lint, linen, or calico of several and (b) The dressing may be l?- bOIled and cooled, or in any of the 10tlOns, or in Friars balsam. (c) Cotton wool, hnt, or gauze (medicated) may be applied wet or dry, next the wound, instead of the above or applied over the dressing. ;d) AntiseptIc powder, such as boracic acid, may be dusted

d d then covered with lint or over the wonn ) fin d d N B -Carbolic acid, cotton wool and ban . . account of many although :uluaLle as J'ears through its J.lCCldclltS ll:l\'lll;'; OCCUllec f 1:1' to be kept in the nll :lpplicutlOll IS. not a e dO IOn Vcssels containing " as a cl res 1110' for \\ oun 8. Ll C..le < < • 0 1 b left about. c.lrl,oltc acid 10tlOIl shoul(. not fe l'nt cotton wool or Tuc cleanliness of dressll1g the have been can be gU:lranteed b y plished . .. . t 1 e:tt 'IUIS can e accom subjected to grea t • used in a closed tin in b \' l)bt:lt)()· the quantIty to be . d' blot to J 0 1 1£ I . It IS a Visa e n hot o"en fur 1a an d b with clean m.tch clean dressings 'nth the han , ut forceps, pincers, sugar tong \ &dc.over a " 'ound do not 'Vhen the blood has eru .e ,.(. b dirt

dIsturb it :tlOuld

3 Rest. 1e ,,?un . . ' . b rest in bed. be kept quiet by s}Jhnt3, slmgs, 01 y

WOUXDS TIIEIR SPECIAL TREAT lENT..

The treatment of wounds in general applIes to these the skin is cut by a f O'1:1ss or other sharp instrument, the kmfe, a pICCC 0 o. ! d The edo'es are clean cut wound IS termed 111Clse . 0 and the wound gapes. . . d wound may be held TI ed es of a large mClse . gafter it has been cleansed, by Barrow stnps

of adhesive plaster laid across the wound with a slight Interval between each strip.

P unctured Wound s. - The wound caused by the stab of a knife, dagger, bayonet, etc., is termed ' punctllred. The wound is usually small, rounded, or j:lgged, and the edges driven in w<l,rds by the '''eapon. 'rhe danger arising from the injury depends upon the situation of the wound, or the depth to which the instrument ha1'l penetrated.

Punct ured wounds must not be probed. Foreign bodies in wounds, when hidden from vie,,', are not to be searched for by probing, they <l,re to be left till the doctor a rrives. (See also Int ernal Hmll10rrhage.)

Lacerate d Wo unds.-,Vb en a part of the body is torn oft'by machinery, by the bite or claw of an <l,n imaI, by an artillery shell, etc., a laceratad wound re ult The parts are torn unequally, so that the surface of the wound presents a very uneven <l,nd ragged appearance.

Lacerated wounds seldom bleed much, but when part of a limb has been torn off, say by machinery, a tourniquet is to be applied loosely round the litnb above the 'wound, readJ to be twisted tight should actual hmmorrhage come on.

Co nt used Wounds .-When from the blow of a blunt instrument, such as a tick, truncheon, etc., the Skill is broken and the part around sevprely bruised, the ,ro und is said to be contused. The

of the wound are uneven and driven inwards ; the hmmorrhage is usually insignificant, a few drops of blood merely trickling from the wound.

Treat as a wound and a "bruise.

Gunshot Woun d s .-When a person is "peppered" at some distance with small shot from a "porting gun, so that the shot has time to spread, the wounds mn.y be wide apart. Every shot causes a small painful wound, from which a little blood oozes, and spendily gets hardened into a scab. Unless the " shot" h",s penetrated the chest or abdomen, or wounded the eye or a joint, there 1S little danger from the injury. The wound from a rifle bullet will show one or two wounds, according as the bullet remains in or leaves the body, forming the apertures of entrance and exi t .

Gunshot wounds are to be covered over by lint gauze, or cotton wool (medicated), if either is to be had, or if not, by some other clean dresf::;ing. 'Vhen the surface of the body has been "peppered" by a number of small shots, do not attempt to remove them, but wTap the parts wounded (a whole limb it may be) in a sheet or towel wrung out of hot or cold water, whichever is the more comfortable. poisoned Wounds .-vVounds may be poisoned at the time of the injury, or may become so afterwards by the nature of the discharges. Under this head ing m igh t be in cluded the bites of an imals, the stings ot

129

insects, the poisoned' d J ) I ,\ oun S caused 1) t' .u rpose y poison ed by d< Yna lye weapon. co " d d ' some 1'11<1 etc ' th . er e 111 detail Jater t"" .' esc wil l be pOl oned by dirt ne 1 t' . , rounds become etc., they are sflicl ' to b g l::mrrol1n d incr s ,c e septIC)) '1'1 . 0 , meaDS putrId, and antise' '. 1e" ord septic are those that p revent ptw matenals and substances septic: with t h e t. a wo u nd becoming putrid or "n't ' " l eatment of tl " L" md has Jittle to d . Ie e cond ItIOns prevent a wound heco ' 0, all that is possible to bhouJd be attemp ted, l1llJ1g se.rtlc " 'hen it i:::; first seeu

For treatmen t soo Rt S· Wh ,1 es, tuJO''' &c en a joint is wound' 'd . or other fo r eign bod or b e , say hy ,1. bullet wrapped up in the is to be When a needle brea e Jmb put III a spliut. the skin and d isappears penetra.ting at once. If the ,,"oLlnd . ' . e patIent to a doctor . t IS near a Joint I l' , Oil a . plint. "When a fi G t 1e JOlllt at skm, do not attemrt to JlOok Imbedded in the is, lly the way it 1 It by rdl'uetionmg" of the hook so tbat 111] ut cnt off the" drcssthen fo r ce the p'o' t 1,1 ' on y the metal is Je:ft and I J In Houo'h tl J . , 100 t to travel onwards l t't, lC::; un, making tlJ.e III 1 It call bIJ \1

FnOST BITE

During exposure to . usua lJy t he' feet fin cold, jJ'l1'ts of the body , g er1"J, n ose, or ea r s lose se t' , nsa IO!;

. und become first wa,xy white, and t.hen congested and of a purple appearance. Sensation being lost in the part, it is often only by the bystanders drawing attention to the alteration in colour of the ear, nose, etc., that the frost-bitte n person is made aware of the fact. T'reatme'Rt. - Do not bring the patient into.a warm room until by friction by the hand, or by rubbing with soft snow, the sensation and circulation in the frostbitten parts are restored. Neglect of this precaution may lead to death of the tissues affected. When . circulation is restored the patient ought to be kept . in a room at a tempe rature a.t 60 deg. Fahr.

BURNS AND SCALDS.

A burn is caused by dry b eat, such as flames, hot mehls, etc. j a scald is caubed by moist heat, such as boiling water, hot oil, tar, etc.

Signs and Sympto1ns.-The effect of heat on the body may be a mere reddening of the skin; if more .severe it may causo blebs or "blisters" to form. "\Vhen the burn is very severe, the deeper tissues of .the limbs or trunk may be charred and blackened. The clothing may adhere to the burned 'ing it impossible to separate them. Tho lmmedlate danger to life is SHOCK, caused by the extent at injury to the skin; the more remote dangers are -exhaustion, severe reactionary inflammationJ deformity from scars, etc. 131

. TTeatment.-(I) The cloth'

Jured part must be Ing over the instuck to the skin th dlcarefully removed. If around with e clothing must be cut quently. If the foot . Id to come awa,y subseca, refully removed d sca ed, the boot must be 1 th ' un omO' the lac d ea er down to the toe of the e an cutting the may fall off, instead of beioO' boot, so that the boot must also be cut all al b pulled off; the stockinO' the scalded part It· onth10', so that it falls away . IS 1e duty of th b prepare the dressing wh'l th e ystauders to removed. 1 e e clothing is being

(2) Immediately co t?e air. (a) When the wound from all' may be excluded b d IS, reddened the powdered chalk &c 1.t wIth flour, whiting b . ,. e part; IS th t b ' Y a thICk layer of c tt en 0 e covered maintained in the 1 0 ton wool, lightly bandaged and (b) 'Vhen blisters position possible. soak or smear ie, or w,hen the surface is oll ve, salad linseed 1p eces of 1m t or linen wi th with i. .;. a.mouel, or cod-liver oiis or 'j .' or cold· ' at, a favourIte zoe 1 ' cleam. Carron P a ·t f' meuy, IS made by " 1 S 0 Imseed oil d r mIXmg equal Jnay be used instead . 1me. water; olive oil the burnt surface' t Imseed oil. When part with one la . IS hex enslve, do not cover the ab t rge s eet of lint b t . au the breadth f h ,u wIth stl'ips o t 0 h::tnd; this is advisable

t cl ressinas one strip can d · subsequen 0 , . lied a s, u n ng . nd a fresh dressll1g npp , be removed n:t a tlme .,£1. is taken off. The shock to before the adJacent stnp tl W0L11d be the case the system is thereby less t laid bare to the \yere the ",bo)e or the budrn n't one' time. When I f 11 the reSS1l1 . a.ir by removn. 0 ad' envelop the part m covered by the ?i1y ressmg't he obtained, with [\ 1 . If that canno" t ' ('otton \YOO, 01 ,Vh tbe face is burnt, cu. ,\ Piece of flannel. en C) ' t or linen, leavmg

" f tl e face out Ol 111 D' t) "mask or 1 d the month. lp 18 th e the nose an f d holes 11 e 011 vaseline: apply it to the ucfe, atI)} mask 111 t e ,01 leavin a or Ie cover over WIth cotton tho or foot is burnt eyes nose, and mouth. tl t is w'lter at the , d 1 water- la " h or scalded, an warn (98'4)-is at hand, place t e terD)Jerature of the body t'l s"litnble dressings . . tl water un 1 L • d illj ured 11mb 111 1e d .t-spoonful of bakmg so a can be got.i and If a deled to a basin-full or the (bicarbonate of soda.). e all" I' e lotion is prepared. otlnng a \.u III tl warm water, a so 11' tel'S' leay e that to Ie Do not prick .the ble?s or. ' . doctor to do If \1'1 CO seyere sbo ck, WbICh (3) Trea t Shoc , - fl 'size must he dealt . 'y burn 0 any, b d a-ccompallles e\ h t the surface of the 0 y with by applymg ell'inks. (Sec Sho,ck.) , generally, and by g f the danger of e\"011 slIght B e very apprehensIve 0 burns of the neck.

13 3

When a Woman ' s Dress catches fire , proceed as follows :-Lay the person flat on the floor at once . Placo h er so that the flames are uppermost; t hat is to say, if the fron t of the dress is on fi re, la y he r on her back, and if the back of the dress is au fire, place her face downwards. The reason for thi'3 position is readi ly understood when it is remembered that flames ascend vertically; so that if the uprigh t pDsition is aS3Ulnecl, the flame will quickly ascend and envelop the body, Deck, and face; or if the person is thrown dOW11 with the flames undermost, they will, if unextir.guI8ht::d, pass over and burn the limbs and set fire to the rest of the dress . As soon as the person is placed flat, smother the flames with anything at halJd, such as a rug, coat, blanket, table coyer, etc. If made wet so much the better. A woman render ing assistance, shonki. hold a rug or blanket in front of herself when approaching the flames. If a woman's dress catch firo I\'hen no one is by, she should lie flat, flames uppermost, smother the flames with a ll ythillg handy, as a table-coyer, mat, &c. and call for assistance; on 110 account should she rush , in to the open ai 1'.

VITIUOL TIIRO\\"IKG.

Vitriol is frequently used as a weapon for dead ly inju ry . If it is dashed in t he face it is a vory seri ous matter. If it tour l18s t he eye it would gene ra lly

134

. . whatever part of the skin is mean loss of '. furrowed and burr.t.. . touched by the aCld IS h all t.he vltnol

T-reatment .-Carefully was. . a sponge dipped m 'ble from the skin, by or baking sod.,81 .h· h SOUle was mg, tepid water, to "11lc. the water to run gently 0\ er has been added, a t an ordinary burn. the inj ured part, then tl ea as

BITES OF

1J tl bite of an animal

Hydrophobia is animals, such .as suffering from rabIes. d &c become rabid. dogs cats, foxes, saliva, and The' poison is con tam cd 111 th beneath the skin and may be conveyed on thchtee beino's 'When the bl d of uman b • , f thus into the 00 h' there is less danger 0 bite is the wiped off the teeth by hydrophobIa, as by wav of the exposed the clothing. It IS or)e that tl{e poison usually parts (the hands an ace enters the body. b't 1,y a dog or other I a"'e of a 1 CUt . Treatment.- n c..... 'n "he attempt to ascer am animal do not lose tIme 1 1 ot ",.,bics but proceed .. , . 1 h or J1flQ 11 bI G whet h",r the aUlmli Preven t the venous. 00 immedIately as fo s. tl h the body by Imme-from the POlSO,-r: . the wound an.d diately placlDg a consh letio Ie a. finger is bitten, It the heart. Suppose, for e:s::amp , 133

should be encircled above the seat of thB bite (that is, on the side of the wound nearest the heart) with the fore-finger and thumb. As soon as possible place a ligature (that is, a string, a piece of tape, a strip of handkerchief, etc.) tightly round the root of t.he Enger; do not ceao.oe to compress with the finger and thumb until the ligature has been applied. (2) Snck the wound vigorously, provided that Y0U1' lips are sound, spitting ont the saliva ; or (3) wash in ,vater (warm water by preference, as it encourages bleeding). (4) As soon as possiLle the " ' olmd shou ld be bllrned by a fluid caustic, such as caustic potash, pure carbolic acid, nitric acid, or if these are not at hand, by a red-hot wire, fusee, etc. It is not suffieient to apply a solid canstic, such as lunar cn.ustic, to the wound; it does not rcn.ch any deeper than the skin, and the poison is at the bottom of the wound. To cnsure the caustic reaching the bottom of the wound apply it on n. sharpened piece of wood, such as a wooden match cut to a point. (5) Dress the wound, and when it is in the upper E'.1.tremity sling the arm. (6) Trc[.!shock, if it occurs.

SNAKE BITE.

TlJe poison of the snake is conveyed from tlJe poison gland alo·ng a channel in tho seIJJont's so tlJat when a snake bites tho secretion i conveyed

136 beneath the skin along the hollow in the fang, and thus gains direct entrance to the blood. Signs and Sympfoms.- 'Vithin a few minutes after l)eing bitten the part ,,·ill swell and feel !:)tiff; the patient becomes pale and faint.i and if the serpent is of the highly venomous species the train of symptoms will be as foll0'Ys: hurried breathing, quick pulse, mental excitement, convulsions, and insensibility.

a ligature (a string, leather strap, strip of handkerchief, brace, etc.) at once between the wound nnd the heart, so as tQ obstruct the voins lending from the sent of the bite. Two or three ueh ligatures may he applied at intervals up the limb and tightly twisted (tourniquet). Apply a fluid caustic, such as caustic potash, pure carbolic acid, or any strong acid on a pointed piece of \yood, burning deeply so as to destroy the poison at the bottom of the \yound. 'VllOn the caustic has been thoroughly applied, but not till then, the ligatures may be retnoved. Sucking the \round is not without dallger, lJll t if 110 c:1ustic is at. hand sucking mnst be employed, the saliva heing immediately spat out, and the m0uth washed out with \yater or spirits and watCl ' , <wd the wound may ue burned with a fusee or in other a ntil:1ble manner. Shock is to b'3 treated in the usu:1l way, and spirit ef sal -volatile (a teaBpoonful in a wineglass o{ water), or spirits (whisky or brandy), are to be freely admini!:)tercd. 137

Bees , Wasps , Centipe d es S . T a r antu l as S ' d '.' corplon s, Bu , pI Jelly-Fish , Harv estgs , etc., may each glye rise to severe s attended by actual d:1l1ger to life il .ymptoms, Hemove th" t' b .) some lUstances. v S mg y sq ueezll1g th . pressure with the oanel of a key when m.op tIle part freely with liquid a " :::; e Wllle, or orand ,1' 1 . mmOl1la, SIJll'lts of the not [,:1n<.1, carbollate of d. . 0' 01 solutIOns of . . so d, 01 potash, WIll relieve . ' . pa!:)te l?l-cal'bonate of soda and spirit of SEll ,

The patiellt'!:)

. III PP 1 C( by the free admini::;tratioll f co 10 or sal volatile. As the harr b .() itself beneath the s1-" 't' est- ug bnnes insect removed by a IS necessary to have the

1:;8

CHAI'TEfl V.

THE RESPIRATORY SYSTEM.

THE air reaches the lun gs by 'YflY of tbe nostrils (or the mouth), the pilarym:. the Im:vnx. the trachea.. and the bronchip-l tubes. -

The Pharynx is the space at the back of the throat and nose, p:utly Ece n behind the tonsil wben the mouth is opened widely; the pharynx gives passf'lge to food and air.

The Larynx (the voice-box, Aclam's apple) is situated on the top (If the wind-pipe in the middle line of the neck; it is composed of mrtilagc (gristle) and conLn.ins the vocn.l cords and the muscles concerned in the production of the yoice.

The Trachea, or ,vindpipe, is composed of strips of cn.rtilage bonnd together by clastic and fibrous tissues, so n.s to forn.: n.n open tube; it extends from the larynx to two inches below the top of the breast-bone, where it divides into the right n.nd left bronchial tubes. Each b1'onchns when it enters the lun g divides into small and still smaller tubes, u:ltil the ultimate recesses ot the lung - the n.ir cells 0 1' air

re::t(:hd.

The Lungs, Rigi jl, tl.Ut.l 1 efl, occupy the greatef partof the thorax; they lie immediately within the ribs, and practically wherever a r ib is feH, whether fr ont,

er

TilE LUl'\GS Ar\ D TOBES. orS " flilnd ·BPipe. 1 L€it lkmchu8. C. Rigl( . . rn a

rone 11al Tubes.

back or sides, there is a portion of the 1ung beneath. Each lung is enveloped in a fine membrane (the pleU1'a) , which allows it to move within the chest during breathing without friction.

The Air enters the chest during Inspiration , and leaves it during Expiration. The movements of ureathing a re caused partly by the muscles of r espi r ation attached to the chest, but chiefly by the Diaphr:ag m , the large moyable muscnlar partition which separates the thorax fr om the abdomen.

Rdspiration consists of two acts, inspiration and expiration. The proccEs of inspiration is chiefly a muscular act; expiration is almost " oholly mechanical. In inspiration the ribs [.\re raiEed by Dluscles attached to them; and also the diaphragm, which in a quiescent stn.tc is com'ex (or curved) upwards, becomes flattened, t hns increasing the capacity of the thorax, and the air flo\\"s in. In expiration the ribs fall, and the diaphragm again becomes convex upwards; tbis lessens thu capacity of the tbOl'ax, and forces tlte air out. The mechanism of r espiration is somewhat like that of ordinary bellows without a yaly e. The ribs may be compared to the boards of the bellows, while the diaphragm corresponds to the leather, the air passages being equi \'alen t to the nozzle. There is this difference between natural respiration and tbe bellows: the boardE' of the bellows can be t close togetLer, ami al l, or nearly all, the ail' fC't'ced out, while

the walls of the thorax when 1 . enclose a considerable' uantit as c o.se as possIble, still forced out. this gIl d y?f aIr, whICh can not be ) IS ea e reSIdual a: F'f eighteen breaths are t k l' ' I teen to Ob t. t' a en pel mlllute III healtb. S IU C IOn to breathinO" when 1 asphyxia, exampl es of whi h" comp causes drowning suffocation I'?: ale afforded 111 cases of , , C 10lUng, etc.

ARTIFICIAL RESPIRATION.

Dr. S?lh:ester's Jrleihod.

rULE th e patient's posdion.-Place th pa IOnt on IllS back on a fi .f . 0 e possible from the fe t ad" SUI ace, lllclllled if e upwar s Romo 11' I clothing from abollt the II ve a tIg It front of tile bod f ee \. and chest, and bare the y as a1' as the . t f I nnfasten the and the to t\t 0 \le ; men, and the corsets in ' v p u 0 trousers m the s1 ld. \ omen. RaIse and support article d 011 a small firm cu.shion or folded R II l ess uuder the shoLllder-blades

ULE .-},Iamimn a freo t , f 0 o' 1Oindpipe.-.\<-Cleanse tbe '1 i (j en 1ance atr 'l.nto the wipe the mouth. dra\H f P d[\,lld nostnls; open and ) cy orwar the patient' · t (j,S far as possible "ud k t f S oogue getting some one'toa. orwarc1 ei ther by piece of cloth or b It WIth a handkerchief or strip of a slightly twisted 0'-' ,g, 01 tape, over the tongue, * 8<:e drownlng, pages 146 and

as far back as the angles of thc mouth will allow; bring the ends und er the lower jaw and tie them securely. The ends may be again fastened on the top of the head to preyent slipping. An elastic band may be used instead of the strip of handkerchief, etc.

RliLE IIL-Iudal e tiLe movements of breathinu·

}'irst: Induu inspiration.-Knecl at a convenIent distance behind the patient's head, grasp the patient's forearms just below the elbow; draw the arms upwarus, outwards, and towards you, with a. sweeping movement, making the elbows almost touch the ground on either side of the patient's head, or crossing the forearms over the top of the head. By

means the cavity of the chest is cn} 'CY' d all' IS drawn into the "luncrs aloc , and S . econdly: Induce -B . th . fl d . & rmg C pabent's exc slowly forward, downwards and inwards t e arms and elbow::> firmly against the body'

WIth the elbows some four or fi 'h f b b " ve 111C es rom the reast one (see Fig. 55) B thO Do " expellod from the lungs, . y IS all' 13

F ig" 53. EXrIRATION.

Rep eat th ese movements, alternatel' and .perseveringly at the ratE! of abo;t a Continlle until spontaneous ureathmg IS es tauhshed 01' untl'l a d t . WI ' , oc or arn ves. breathing commences, regulate the artifiCIal rcspLra boa t o correspond ""ith the natural

F ig. 54.

effort. Hopes of restoring the patiei1t may be entertnineJ even after two hours' time.

HULE IV.-E.rGite respiraiion.-,Vhilst the aboye measures are being taken, other usefLl1 steps may be employed, snch as smelling salts or nufl' to the nostrils, and dashmg bot and cold water alternately oyer the head and neek.

RULE V.-Illduce circulation and warmth after natural breathing has been restored.. \Vrap the patient in dry blankets or other covermg, and rub the limbs energetically towards the heart. Promote "'armth by hot flannels, hot-water bottles, or hot bricks (wrapped in flannel) applied to the feet,. to the limbs and' bod v. ,Vhen the power of s\Yal1owmg bas returned giye of hot water'r tea or or of winc, brandy and water, etc. rhe patIent oe kept in oed and encouraged to go to sle8p. La] ge poultices or fomentations applied. to the aul bnck of the chest will serve to aSSIst breathmg.

,Vatch the patient carefully for somo time, .to sce t1l::lt the breathino' does not fail; should any SIgns of failure appe'1.r, atonce begin

HOlcard's llIethocl.-This method IS e::;peCilally applicable to caseA 'when the pc.'ltienL's arm is ; Deal ,,,ith the clothing and tongue, etc., as descrIbed under the Sylvester method.

Turn the patient on the back. : lace a r?l1 0: clothing beneath the body, so a.f:I t.o r?"se 1.he regIOll 01

145

tho stomach above the level of any other rart of the Knoel beside or astride the patient's hips, and ,vlth ballFl of tile thumbs resting on eiLher side of the pit of the stomach, let tbe fingers fetll into the grooye between the short (fa 1"0) ribs, so as to afforu I he hest grasp of the waif':lt. Now, using the ];;nceR a pivot, throw all,Y0ur weight forward on your hands, and at the same tIme squeeze the waist between them itS if you wished to force everything in the chest II p_ ward. toward the mouth; deepen the presFlnrc while can count slowly ], 2, 3; then lot go a fil:al which springs you baclr to your Ii l"s.t knecllllg positIOn. Remain erect on your knees you can count 1, 2, 3. Then repeat the samo motions as before, at a rate gradually incre:1sed from 4: 01' 5 to 15 times ill a minl1te, and continue the movements with regularity. Induce circulation and warmth in t.he manner described under Rule V Syl "ester's method, "

'Vhell, a sufficient l111mber of assistants are present, IIoward sand Syl vestCl':s methocls may be combined, the pressUl:e Oil the pit of the stomach (Howard's method) belUg made at Lhe same time as the presFlure all the ribs (Sylvester's method).

\Vhell from any C:1use, as fractured ribs, neither of the aboye methods can be carried out, Laborde's rnetho(i of artificial respiration should be tried. It is especially useful in suffocated children. It is c:1rried

out as follows :-The patient is placed on his back; the mouth cleared; the tongue is r. handkerchief 01' something to prevent it slipping from the fin.o·ers-the lower jaw depressed; the lOnO'ne is forward and held for two seconds in that position, then aUowed to recede into the mouth. These be repeated about fifteen times a minute. After treatment is the snmc as in Sy h'ester's and Howard's methuds.

To RESTORE TilE ApPARENTLI DROWNED.

Persons completely immersed in water for even ten or fifLeen have heen restored by artificial means. If, therefore, the body is recovered within Do reasonable time, absence 01 signs of life is not, to deter immediate attempts to restore animation.

Drowning persons a.ttempt to breathe whilst Stl bl'1erged, and, in consequence, water is into t,heir ail' passages and they become asphyxIated insensible. The first thing to do ,,,hen the body 18 recovered is to O'et rid of the water and froth obstructing the air and th en to artificially breathing. This is best accomplished by: loosenm.g th e clothing and opening the mouth, und c1earmg both It and the back of the throat. The patient shonld then 111) turned face downwardl:3: with a pad below the cbe t ::tlld with the forehe:1d upon the right fore:trm. "Whil st in this position apply pressure 1y the hrmc1s to the

Hi

patient' s b:1lk over Lhe lower ribs, and keep the pressure up for s.econds. '1'nrn the patient Oll the righ c sIde, mallL/a lllmg that position also for three seconds. Repeat .moVe ttlBnts alternately, as long aR l. roth aud water ]Sf:H10 from the month 'fl1cso 0' e "

• • " /1 1<1m themselves tend to promote respiration, but It IS usual, when the air passages are clear of froth and water, to adopt Sylvester's or Olle of the otber methods of artificial respiration already WhIle performing these operat.ions selld to the neal(,;,;t house to prOcul'e l>bllkets and dry clothinO' hot·water uotUCI3, etc., and to fetch a doctor. 0'

STRANGULATro:-r.

Owing t? constriction o! tbe 'Yindpipe by a co rd, a rope, tlglJtcned llecktlC, etc., round the nock, the brcathll1g 111a.y be arrestcd l'..nd asphyxia caused. the constrictiug ba.nd and com mence art,]nClal rel':piration.

When a. fore!gn body, as a coin or piece of meat obstructs the mr passage, suffocation may ensue.

T1"ealm enl. - Open the month, forcibly if need be ; pa123 the forennger right to the back of tho throat and attelnpt to di slodge the obstrllctinO' body' if yomitino}'esults from tbis step so mnch If tbml1p the back l)[l.rd betwcen the shoulders whIlst the hend is bent forward . 'iVhen the foreign L

body icl removed, but breathing is suspended, commcnce arti6cin.l respiration.

HANGING.

Grasp the lower limbs and raise the body to take the tension off the rope, Cut the rope, free the neck, ana commence artificial respiration.

SUFFOCATIO T BY SMOKE OR GASBS.

TIemove the patient into the fresh air, loosen ,clothes, and :flip the bare chest with a towel, wet wIth cold water, for 15 seconds. If this fails to restore ing, apply artificial respiration. Before ,entermg ,a buildiI1O' full of sUloke, tie a handkerchIef, wet, If pOlSsibl;' round the head, covering ,the nose and mouth. It is well, to move slowly, keepmg low, or eveu crawling whilst in a room full of smoke in search of a person. Every opportunity or letting in fresh air by opening doors or 'windows should be seized.

SUFFOCATION BY SWALLOWING VERY HOT ,VATER.

1'his accident not infrequently occurs to children attempting to drink from the spont of a kettle.

T1'eatment. -Applya sponge or flannel (or other) cloth, wrung ont of very hot water, to the front of the neck from the chin to the top or the ureast-bone, and set the patient before the fire. Oi ve, ice to suck it can be had, or if not, cold water. OlIve or salad 011, a dessert-spoonful at a time, will soothe the scalded throat and tend to case the pain. 119

CHAPTER VI.

POISONS AND POISON LNG.

WilEN a person taken poison, the sudden onset of theIr SOOll after haying taken food 01, drll1k, or after havmg swallowed some substance mad vertelltly, may be the first intimation of the , danger, 'When taken with suicidal intent the JXlLlent mayor may not conceal the fact that poison has beon swallowed. The nature of the poison may be known to the patient and declarcd' may be known. to the patient and concealed ; may be a.scertamed by the bottle, box, plant., powder, etc" whOl:ce the pOlson was obtained j 01' tile nature of the pOlson may be unkncwn.

SUM;\IAUY OF SIllPLE DmECTI')NS Fon THE TnEAT)IENT OF

Send for a doctor at cnce, stating what has occurred.

When the nature of the poison is not known and the patient is not insensible, give: -

,1. M il,k.-It is safe to give copious dranghts <* mIlk , MIlk, when swallowed, clots 01' coagulates, anCt the pOlson may be thereby enclosed i:a the milk clot and the whole got rid of by an emetic. Cream and beaten IIp together may bo gi \'cn as \roll as or lllstoad of the milk.

150

2. Eggs.-Beat uq) a couple of raw eggs with milk 0:1: water. The raw egg sets or coagulate in the stomach, and as in the case or mille mu.y include the voison in the clot.

3. Oils.-Give several spoonfuls of olive, su.lad, or linseed oil. Any vegetu.ble or animal oil, such as I.hat in which sardines are preserved or cod·liver oil, mu.y be given. Mineral oils are not suitable. The oi 1 soothes the surface already inj ured by the poison, and protects the uninjured parts of the stomach or gullet. Oil is not to be given when phosphorus is the en nse of the poisoning.

4. Tea. -Strong tea (a handful thrown into the kettle and boiled) acts as a lleutru.lizcr of many poisons and is always sa,fe.

5. An Emetic.-Give an emetic, except Ichen it seen that the lips and mouth are stained 01" [Ill ,-ned (by acids (,1' alkalies). The emetic may be :-(a) a desse rtspoonful of mustard ill a tumblednl of lllke-" 'arm watcr; (b) a tablespoonful of salt in a tumblerful of lu kc -wu.rm ' wntel'; (c) for a young child, n. teaspoonfu1 of ipecacuanhu. \vinc, repeated twice u.t intervals of 15 mill utes, l1ln,y be gi \'cn instoad; (cl) the fiuger or u. fen,ther passed to the uack oE the thl'ou.t and moved about TUU.Y serye to ullion.d the stomach. The ;":l1lcti0 may be given first, or after oue or more of t.rle ahove rem ed iel:! have been admi,nistercd.

G. Treat far Sh o ck when it ,occurs.

151

When the nature of the poison is known ._

Treat the pat' t 1 . whe tl . on t)e general lines laid down to}11 pOlson IS not known. If an acid is known

give an at. OllCC; ::t1l(1 h I In.ve een the pOlson, glYC ::tll acid .

In all cases, any vomited matler and food or. other substance suspected of being pOlson, should be preserved.

BROAD FACTS 'WORTHY

OF

When a person has swallowed a poison and threatens to go to sleep, keep him awake .

When he seem s going off into a fl t clash cold water 0:: his head, face, and nec :c.

thLre are no stains about the moul h gIve an. em"'tic, also eggs, milk, oils (except poisoning ), and end up WIth strong tea.

When there are stain c d ... the mo "h . • glve eggs, mllk and oilso but no emetic. .

POISONS ARRANGED ACCORDING TO THEIR ACTION.

NARCOTICS.

Opium, or one of the substances fron: it, such as Morphia, or some one of Its preparatIOns, such as Laudanum, or Paregoric, or some of the popular remedies sueh as Cblorodyne, sy rup of poppIes, and yarions doothing syrups and cordials,. all the poisonotls narcotic properties assocIated wIth the name of opium.

.

S!Jmptoms.-Tendency to go to sleep, whICh contilll{es to increase until sleep becomes deep and breathina stertorons. Finally, it may be impossible to. rouse patient, and death is imminent.. contracted to the utmost extent (l!ll1-POll:t pupIls) ) they do not respond to light. The face IS pale, tbe skin clammy, and a smell like that of poppyheads may be detected in the breath.

.

Treatment.-Give an emetic and keer: ebe patIent awake. Nevergivo an emetic when is inseusible. Keep the patient awake by walkmg about, slapping his face and neck or chest With a .wet towel, and by giving strollg to drmk. Slapping the soles of the fc.et a shpper be tried w hen other means 0E rousing fall. ) Jmpl oy artificial respiration if the breathing has ceased.

IKEnnrAKTS.

Alcohol is the chief representative of this class. it is seldom active treatment iR reqnired ex!!ept cases of collapse from drink (see page 114).

DELIRIANTS.

.Strychnine, a .p0i.ol? used for kiI1ing dogs, cats, vermm, etc.; PrUSSIC ACId, sometimes used for the same purpose; Belladonna, either as a drug, or as the berries, etc., of the deadly nightshade plant; Digitalis, either as a drug or as ·the leaves of the fox-glov9 plant ; Hen bane, Hemlock, and several varieties of plan ts as flll1gi (often mistaken for mushrooms), seeds, monkshood, etc., are rank poison.

SY7nptoms.-Each of these poisons has its o"n symptom. Conv.ulsions and several nerVOllS sympappear early 111 most, and are the most prominellt eVldence of this kind of poison having been taken.

Tnatment.-Administer an emetiJ, if poison is known to have been tak en, before convulsions or insensibility come on. ·When the patient is delirious, capable of swallowing, give a tablespoonful of charcoal in a half teacupful of water. vVhen ?ehnum or conyu]sions set in, dash jugful after Jugful of cold water over the patient; give strol16 tea or coffee, and, should and cessation of

, 1 r a r tificial r c...;pi ratioll. rcspiration threaten, app) '1 'lapnin o ' with a. . h Id t th o nostn s s J"' 0 Smellillg salts eo. sal volatile \\'ill help to wet towel, brandy olh t' . t until the uallgel'OUS f'lt imulate and support t 0 pa len period is ov el' ,

COllROSl\'ES.

Alkall'es are the chief examples of Acids and lilis class of poisons . I taken as . d The acids most common y 1) A Cl S - " he s.:t lts of lemon, salts of sorre ; are'.., Oxalic (oil of vitriol) j Nitric (a.qua Carboll c; Sulphurl.c ., ( irit of salt). fortis) ; H ydrocblorl? :Re mouth, throat, SlI?n?'li01ns.-Burmng pam t ' . . or tl,e lips and •1 '1 '1 t ste' s 'O\,mll1g und stomach; dark-bro\\,ll colour; mouth of a wblte, .Y. ' h 'k' exhaustion and 1 ' d vomltmg: s 00), b r rctc1l1l1g an .L.'. iV-hen tho poison is car 0 lC collapee, or helpR to di close the fa,ct. ac id smen of.t U I the mouth out frcely WIth l ' t ' 1' en f - FIrst was 1 I 11- 1'ea I l. • lkr l' mixture such us cia '-, lin:e 'water or in' water, milk, or whitin g, magnesIa, or \Val \ patient sip some o liyc oil, and ScCII a'" bal;eV watcr, milk, D I n llll.SSU ,., < .' of it. emu tl Id co'o'S ben t en up ay be given subsequen y, at 00 etc " m 'Il Treat shock. . with water or mi "-. . P t h Caustic Soda, QUlCk Alk lies -CaustIc 0 as , , 1 S a . < '" the prim:1 pal exnmp.e Lime, and strong Ammollla aIe 155

of a lkaline cOt'L'osi \'cs. 'J'hey cause sym [)tOlllS resembling those set IIp by acids, ftlld it is only uy seeing the bottle 1ab81 that unskilled pel'sollH (;(1,ll be sur e of distinguishing between acid alld alkalille poisons.

Treatment.-\Vash the mouth Olle 'with an acid mixt lll'e, ns lemon juice or vinega r, clilu ted \rith an eq nal quantity of water . Afterwards givc milk, olirc, /:ill1acl, linseed, or cod lin'r oil, or eggs Leaten up iu >I',ltcr or milk. Trent shock.

Do not give an emetic when the lips and mouth are seen to be stained by a corrosive fluid, whether acid or alkaline, as vomiting is lik ely to further injure the corroded surfaces of the stomach, etc .

IHnTTAXTd (METALLIC POISON ') .

everal of the metallic irritants n.re also carro Hi I'es. The chief substances contained ill this group are :-Arsenic (Fowler's solution); l\Iercury (corros i\'e sublimate); Antimony, (buttcr of antimollY, tartar emetic); Lead. (saga r of lead); Copper (verdigris); (lunar caustic); Phosphol'u!:) (rtl.t poi 0 11, matches).

Sl'mptoms."-A burn:ng pai n in the throat and at the pit of the stomach; a mctaLic L-I.::ite in tho mont h ; l:etching n.l1d Yl'miting and grcat dread and alarm. The appeal'anC0 of the ,"omit, such a::; tIle

1·56

. . . b copper, and the green colour III dark may assist m that phosphorus gl?ws III , determining the by giving an '1'1·eatment.-Asslst t;eit has acted gi\'e a couple emetic. After or b.efor . . ·lk or if they are

b t P m water or IDl , d or eggs ea en u. . "k strong tra, an not at hand gIve plall11 "e or salad oil. . h ase of phosp 101 us, . t' except m Lee .. b metallic irn tan S IS

Especially after Yprompt treatment the , t ecessary to countem .., In. r depressing mfluences 0 is

GEXETIAL _ OTE, , d Lle action and techmcally

Many poisons have a . than 'one of the headmight be grouped un1del. cleall'ng \yjtll a poison of , The I'u e III ings glyen. , t the trn.in of symptoms, . 1 natnrc IS to no e , thIS comp ex . t the sy'mptoms anse, d t t t the patlen, as es an 0 rea . 1 directions given on pug . according to the genel a 149 to 151.

157 CHAPTER VII.

INJURIES OF SPECIAL ORGANS.

TilE EYE.

The eyelids move upon the eyeball, moistening anL! cleansing the surface j and when closed the eyelids prevent foreign Lodies injuring the eyeball. A mucous membrane covers the inside of the eyelids and thE; surface of the globe of the eye, and it is on this membrane that foreign bodies collect.

FOREIGN B OD Y IS THE ErE.

Treat17lent.-Prevent the patient rubbil1g the eye, tying a child's hands down if llecessary. Pull dmYll the lower eyelid, when, if the foreign body is seen, it can be readily removed with a camel's hail' brush, or the corner of a handkerchief twirled up and wetted.

·When the fureign bodyis beneath the upper eyelid:(1) Grasp the upper eyelid bet,,'ecn the finger and t humb and lift it forward from off the eyeball; then push up the lower eyelid beneath the upper, and let go. The hail' of the lower lid brushes the inner surface of the upper lid and may dislodge the body. Should a single manipulation not be successful, repeat it two or three times if necessary. If the foreign body is not dislodged, call the 8rrvices of a doctor as

soon as possible. When, hu/c6Ve1, shlled help cannot be had, as on board ship, or elsewhere, proceed as follows to the inside of the upper eyelid :Seat the patient so as to face the light; stand behind the patient, steadying the head agaillst tbe chest; place a tooth-pick, wooden match, knitting needle, or any narrow, firm rod, on the upper lid of the injured eyo half an inch above the edge, pressing it backwards HS far as possible. N ow seize the upper-lid between the finger and thumb, and pull them upward 8 over the rod. The eyElid will 10 o"oded, and tho foreign body, if it is there, can be readily seen and removed. (3) ,Vhen a piece of steel is em bedded ill tho eyebalJ, drop a little olive or castor oil on the eyel)all after pulling down the lower eyelid, close tho lid s, npply a soft pad of cotton ·w00101l the lid, and secure by a bandage tied sufficiently lirmly tu k eep the eyeball steady, and take the patient to a d octor.

FOREIGN BODY THE Kill P A '. AGE.

,Vhen a doctor can be had, even within twenty-fon r hours, nover attempt to treat a patient with a foreig n body in tbe ear. A pea in the ea.!' is a serious accident, and any attempts at removal may lead tr fatal consequences. If the patient, a child especia.lly, cannot be induced to keep the fingers from the tie the hands down, or cover up the ears by tying a handkerchief round the bead and over the ea.rs. If

an insect is in the eal' 'J -passG.O'(, fill th OJ , when the insect '11 fl 0 , e eDr 'l'i(11 o}iye J ever syringe or nrobWe]th oat, und mG.Y l)e removed 1 e ear. .

FORETGN BODY lN THE NOSE

Induce the patient to bl . a pinch of snuff or pe ow the nose violently' gi\'e oat . pper to the Ul1a.a' t d ) . 8. 0 mduce slleeziuo" ., < liec e out the nostrif up ,rUler or wlslodgement The" . \ 1 1 ,rater may e(fect f' . Ie ]s no 1l11meu' t l orelgn body, say a shirt b . Ia e o:mgel' from n ntton, m the ll ose.

, TIm CUEST (TrlOflAx).

1 he thorax is bounded . (sternum), and the rib In by the breast-bolle vcrt b Ileal 1 aO'es' b h' 1 1 e"ra co llmn (the 1 0 1 . 0 J e mc ly the either side by the ribs \b C vertebne ;, and on by the structures at th J. 0"\ e, the thOlUX is uoullCled by the diaphrag'm ( .ed of the neck, anu below ft' ml 11 / the 11 ' pal'l IOn ,y hich separates ih' b mova) e mnsc"lllar e c est abdomen.

TIlE ORGANS OF TIJ' C Th 1 E HEST (TrrOTIAx)

..e leart and luno's 0'" • • posItIon and tl'uctl1l'e of the t.be chest. The t he organs of the eircl11ntiOI ( eart IS with 'Vounds of the 1 eu. 1 see page 10). fa tal. J 1 tare uSL1ally instantaneou Jy

The Lu n gs OCCllI))' tl1e chest-front, uac·l, and

sides. They are described under the Respiratory system (see page 138).

'VOUNDS OF THE LUNG.

'When a rib is broken and the ends driven inwards, the leura and lung are' apt to 1:e torn.. Thes.e organs p 1 b . . red bv stab wlth a kmfe, stIletto, or maya so e lllJU h'b A 'fie bullet ba onet penetrating between ten s. 1'1 . . mI y traverse the chest, wounding the lung III Its passage. .

S"(jns and Symptoms.-Difficulty of breathlllg, symptom; of collapse, faintness,. spitting of blood (red frothy) usually indicate lllJury to lung. ,' t rna beneath the skin 01' llltO ca'i y of Ihe chest. Internal may lesult'l thte . . th cavIty of the c les , Llood accumulatmg III e . .

. Hor slowness of breath, blulTc:d VISIOn, causll1g pa , d l' . d f intness !ceble pulse, sighing! yawning, e Iflum, an a · , g oing on to lUlconSCIOusness. . d

T' t t -Lay the patient down wIth the hea 7 . to suck apply ice over the illj urod part, low glVe lOe, '1' t the k ' th" room cool by free ventI atIOn, urn. ocp J .' d'd Do not be a aticnt towards the ll1Jure 81 e. .., . E<lndao'e round the chest when the lung IS ureg bYf a rib, as there is danger of the roug 0 t h e fracturc causing further .damage to the g. Should the injury be accompamed by a surface wound, apply clean dressings, &c.

THE AnDOMEN.

abdomen is bounded above by the diaphra gm (midnff), below by the bones of the pelvis, b ehind by the ' ,ertebral co]umn (the lumbar yertebroo), and ill front and at the sides by th e muscular walls of the abdomen.

Wounds of the front wall of the abdomen may be either vertical or transverse. 'Yhen the cavity of the abdomen is opened, the intestines or other organs may protrude through the wound.

T1·eat77unt.-(1) ,Yb en tbe wound of tbe front \vall of tbe abdomen is vertical, lay the patient down fiat with the lower extrelllities straight j coyer the wound over by a pad of dry lint, or linen, and place a bandage round the body fairly tight. (2) 'Vb ell the wound is tranSYen3e, bend the knees so as to r elax the tissues of the \ynll of the abdomen, and raise the shoulders to allow of the edges of the wound coming together j apply a pa.d and bandage. (3) 'Yhen tl18 intestines or oth er protrude through the wound in the abdominal wa.ll, 1)cnc1 the knees, r aise tbe shoulders, and apply lint, a towel, or a clean spongo wralJped up in soft linen, wrung out of warm. water! and keep the part warm until the doctor ani ves.

Every wound that illj the stomach, liver, spleel\.\ in testi nes, or pancreas, must trayerse the abdomen. 131 000 or the contents of the stomc.ch or intestines

1()2

. t the abdominal cavity, '11 therefore escape 111 0 symptoms of internal hromorrhage.

THE ORGANS OF THE ". d · t 1 beneath the The Stoma ch imme la e y of the stomauh" j ost below the breast-bone.

Fig. 56.

163

Injuries of the stomach are attended by extr eme collapse, and sometimes by retching, and vomiting, of dark blood li ke coffee grounds.

TI·eatment.-Lay the patient down on his back, apply an ice-bag over the pit of the stomach. Nothing should be given by the mouth.

The Liver lies in the upper part of the abdomen, where it is mostly covered by the right lower ribs.

Illj Llries of the liver may be caused by a blow over the organ, by fractured ribs penetrating it, or by the stab of a sharp weapon, or by a bullet. The great danger of a wound of the liver is hremol'rhage, the blood escaping into the cavity of the abdomen. The injury is attended by pain and swelling in the region of the liver, and by the signs and of internal hremorrhage.

T?·eatment.-Lay the patient down, give icc to suck, apply ice over the region of the liver, turn the patient t,owards the right side.

Th e Splee n lies beneath the ribs at the upper part of the left side of the abdomen.

The of injury and the dangers are similar to those of the liver, and the treatment is similar, only that the patient should be turned towards the left side. Injuries of the spleen are usually speedily fatal.

Inj u ries o f the Intestines canse symptoms of collapse, and internal hromon-hage may occur, or I:be uontents mar escape into the cavity (\f the abdomen, b1 2

Tl'eatm,ent.-Keep the patient lying down and as as possible. Apply a large pad of flannel or cotton "'001 to the abdomen, kept in place by a towel applied fady tightly round the abdomen and pinned in three or four places. Give nothing by th.e mouth.

The Kidneys lie at the back ill the region of the loin. They may be lnjured when the lowast ribs (the 11th and 12th) are fractured by a crush, blow, or by a bnllet 01' sUUle sharp weapon. Blood wou1d escape with the urine, and there would be pain ann perhaps swolling over the injured kidney.

The Bladde'i lies in the pelvis, and may be wounded by a fracture of some of the pelvic bones. The signs and 8ymptoms would be either inability t o pass water, or if a little is passed it is tinged with blood.

Treetf7ILent. -- When either the kidney or bladder is wounded, keep the patient quiet until the docto r arrives, and meantime apply hot fomentat:ons 0 ;e r the painful or injured part.

Rupture (he1"niaj consists of a protrusion of an internal organ, usually the bowel, through the wall of the abdomen. It mo,st frequently occurs at the Should a sudden swelling, aecompanied pain and sickness, take place, send for a doctor llland meanwhile put the patient easy position, and plaee ice or cold water applIcatIons on the affected part.

CHAPTEll VIII.

BANDAGING.

Esmarch's Triangula B d described in Cha tel' I r an age. has been part of the body.P . It may be applIed to any

F.or the scalp (Fig 57).-Folcl h b lk ll1ches de 1 h a em a out ep a ong t e lower border, place the

FIG. 57.

the h.cad so that the hem lies on the forean the pomt hangs down at the back' th carry the two ends round the h(.> d ) en at tho back, and "::;"d

. Ie on e. ol'ehcad j then draw the point downwards and turn It up pin it on to the top of the head. I

I n applying this bandage, care must be talr en to put t he h em close down to the eyebrows, to carry the ends above, not over, the ears, and to tie them close down t o t h e eyebrows and not high up on the forehead. k

For the fo;ehead , side of h ead : chee , and for any part of the body which 1S round (as the arm or thigh, &c.), the narrow bandage must h e used its centre being placed 011 t'he wound, anel th e ends being carried round the limb and tied over the wound.

For t he s h oulde r (Fi g. (8).-Place the centre of n. banda ge on the .injured shoulder, 'I'ilh the POlllt running IIp the side of the ne ck; turn up a hem ; carry th e ends round the m:ddle of the a r m and tie them; take <1 second bandago) fold it into n l)l'oael bandage, place one

FIG. 58. (,l1,el oyer the point ot tbe frst . r Landage t sling tbe arm by carrymg the end Ol the bandage oyer the sound. shoulder, ami tylllg at the s iel e of the ne ck; bring the point of the first 11llclcr that part of the sling resting on 1.!1Jured s houlder, draw it tight, turn it dO\YIl , and pill It.

lG7

For the hip (Fig. 5G).-Tie a n arrow bandage round the body aboye the haunch-bones, tying the knot on the same side as the injury j take anoth er turn up a hem accord i ng to the size of the

FIG. [9 .

pa tient, place its centre on tbe wound, CUlTY th e ends r ound the thigh, alld tie tbem; then carry the point uip under the waistband, turn it do·wu o,er the knot, aw l pill it.

For the h a nd (Fig-. GO) .- Sprcac1 ont a bandage, place the wrist on the !Jordei' ",ith the fingerf'l towards

the point; then boring the point over wrist, pass the two ends over t he wrist, cross, and tIe them.

60 .

For the foot (Fig . 61). - ·Spread out a bandage , place ti.le foot on its centre with the. toe towa.rds the po int, draw up the point over the mstel?, brmg the two ends forward, cross, and tie them e1 ther on the sole (if to keep a spl int on) or r ound the ankle.

For the chest (Figs . 62 63): - Pla.ce the middle of the bandage on the mJ ured slde, ,,11th the point over the shoulder; carry the two .ends round the waist and tie them; then draw the pomt over the 6houlder and t ie to one of the ends. 169

For the back. -The bandage is applied as above but beginning by placing the bandage on the back. '

For the knee. -Spread out a bandao'e fold a h na.rrew bern on the lower border; lay the point on the thIgh and the middle of the lower border just below the knee-cap, cross the ends first behind the knee then over the thigh, again under the knee, and tie in' front below knee-cap. Bring the poiut (A) d6wn to (0) (see Flg. 64) and fasten with a safety pin. If the

FIG.

FIG. 61.

Fw.

FIG. G3.

1/0

bandage is not large enough to be br?ught the second time below the knee, tie it on the thIgh.

FIG 64.

?Of the elbow.-1' his is sirni1ar to that, fOI knee, the point and middle of the lmyer border placed on the back of the arm and forearm l'csl'ectn el,) .

CHAPTER IX.

CARRYING PATIENTS.

In accidents where the patient bas been rendered unable to he may be carried by the bystanders illJ.kll1g C1th er of the following seats :_

65.

(1) The four-handed seat made by two persons grasping their left wri sts with their right bands, theu grasping each o,ther's right wrist with tLeir left hands (as Fig. 65).

After tLo hands are clasped togetller, t he bearers stoop down behind the patient, who its on the

FIG.

FIG. 67.

hands, and at the same time places one cum round the neck of each bearer.

This seat is used where the patient is sufficientl.v conscious to gi ve some assistance to the bearers and is able to use his arms, but is unable to walk. To lower the patient the bearers stoop down or kneel on one knee, gently place the patient on a chair or bed, &c., a nd unclasp and withdraw their hands.

The two-handed seat is made by two bearers clasping their bands as in Fig. 66, and placing their free hand on each otber's shoulder. In case of the patient being a s1)ort person the bearers should place t heir hand Oil each other's hip (as sllOwn in the figure), instead of on the shoulder.

Instead of the grip shown in Fig. 66, either of those sho ',Yll ill Figs. 67 and 68 may be used. If that shown in Fig. 68 be adopted, it is well to wear gloves 01' to hold a handkerchief in the hands.

This seat is used when tile patient is unable to gi ye any assistance with his arms, and may be used to lift a helpless patient :-

A bearer on each side of the patient stoops down, pusses one arm under his thighs, near the knees, and clasps the hand of the other bearer. The bearers then pass their arms round back of the patient und grasp each otber's should er (or hip). To lower the patient tbe bearers should stoop down or kneel on one knee. 'When the lower part of the patient's body is resting uj!I)'!l the 175 Fm 69.

1/6

bed, or place where it is desired to plaee him, the bearers should unclasp the bn.nds wbich are under his buttocks, tn,king en.re to SU[POl't the upper part of the body, which can then be gently lowered.

The three-handed seat i3 a modificn.tion of th e above, n.nd is sometimes used for a short p erson or child.

It is marIe as follows :-One bearer grasps his ow n left forearm; the other bearer grasps the right for earm of the first bearer with his left hanel, and the first bearer grasps the left for earm of the second b earer with his left hand; the second bearer places his ri g ht hand on the left sh ouleler of the first bea.r er. The forearm should iB all cases be grasped slightly n.bove the wrist (Fig. G9).

To lower the patient the bearers shoulel stoop down or kneel on one knee, gently place the patient on a chair, bed, &c., and unclasp and withdraw th eir hands.

One bearer may carry a patient uy the Fireman's lift as follows:-

To th e Patient-Turn tbe patient ft.... ce dowllwards with his legs extend ed and arms close to h is sides; place yourself at his h ead, stoop dOWll , 'Slightly raise his head and shoulders, and take bold of him close uuder his armpit::!, locking your hands 0 11 his back. Raise his body as higb n.s it cn.n be lifted with your hn.nds n.nd arms in. tb;tl position; the n resti'ng his body n.s far as possible on your left kne e, sbift your arms and h.ke him round his wn.ist, lock

177

y?ur hands and lift him to an . his bead resting 011 your upl'lght position thlgb supporting as much f s ?ulder, your left

Holding the patient in hIS. as possible. arm, grasp bis left wrist with WIth your left his left arm over your h d rIght band, throw drop yourself into a stoo ; ea , . at the same time with your left ar;;ng , go of the hIS thighs, The place between yonI' shoulders and , I Y "Ill now fall across . . ,,) OU S 10uld now rise t . pOSItIOn and l:iala' 0 an uprIO"ht .' nce It carefull ').1 f b p.atIent's left wrist to your I y. rans er the rIght band free for st 1.' land, and so leave your th' eae j III o· yourself 'h . e patient downstairs . d b , " on carrymg

To Lower the bfdder (See Fig, 70), left wrist to your rio'ht I 'd lallS er the patient's between his thio'lls a b d l]an ,.take your left arm from 1 0 c n p ace It 1'0 d tl ' t 1em to the rio-ht-hand 'd f un 1em, brmginoupon your rio-bt knee 0 b,ody. Sink ground whileo you SLll;po 't s legs rest on the place your left arm' 1'0 1 d J.e y ou your left thigh, of his left wrist and IS nght .shoulder, let go neath his left' arm pUd mg nght arm undertl an round hIS baek I 1 . gen y Oil the ground (F" o. 71) , P n.ce lllU N 13 '1'1. 1M " . ,- uose bearers who' f t of the patient on I . ple er 0 carry the weight " loft)) for 10 shoulder should ren.d above an Vlce versa throughout the N

The plan of carrying the patient by the arms and l('(}s, with the downward.'3, commonly called the I( frogs' ma?'Ch," must never be used, as dea.th may ensue from this treatmentJ

FIr:. 70.

FIG. 71.

'Whcre a proper stretcher cannot bc oLtait,CC1, c.. tempora.ryone may be made in either of the following ways ;-

(1) The sleeves of a coat may be turn ed inside; two stout poles are then pasced through them, and the coat buttoned. This makc.:; a good seat. (Fig. 72 .) 'rhe patient sits on it, and rests against the back of the first bearer. N 2

If a 10n cr er stretcher is required, two coats must be treated in the same "way. (Fig. 73.)

7:1..

FIG. 73. -

FIG. 74.

( ? ) A sack maybe taken; a hole is made in d "'. b tt d two poles passe each corner of the 0 om, an .) through the sack and out of the holes. (FIg. 74.

181

t3.) A large piece of carpet, sackiug, tarpa.ulin, or a blanket may be spread out, and two stout poles rolled up in the sides.

Two then stand on each side. They grasp the middle of tbe pole with one band, and near tbe end with the other. To carry the patient they must walk sideways.

(4.) A hurdle, broad piece of wood, or shutter ma.y be employed as a stretcher; but if either of them is used, some straw, hay, or clothing should Le placed on it, and then a piece of stout cloth or sacking; the sacking is useful in taking the patient off the stretcher w hen he arrives at the bed-side.

Always test a temporary stretcher before placing the patient on it.

Temporary stretchers must be carried, and the patient placed on tbem as laid down in the" Stretcher Exercises. "

Never allow stretchers to be carrieL1 on the bearers' shonlclel's.

Always carry patiem feet foremost, except when going up a hill. In cases of fractured thigh or fractured leg, if the patient bas to be carried down.hiB carry the stretehel' head fin;t.

In carrying a patient on a tretcher care should be taken to avoid lifting tho stretcher OTer ditches or walls, but ',,,here these cannot be avoided the stretcher must be carrie '1 in the following ,yays :,-,

FIG.

18:2

To CROSS A DITCH.

In crossing a ditch, the stretcher should be lowered 011 the ground, with its foot one pace from the edge of the ditch. Nos. 2 and 3 then descend. The stretcher, with the patient upon it, is afterwards advanced, Nos. 2 and 3 bearers';" in the ditch supporting the front end oE the stretcher, while its other end rests Oll the edge of the ground abo\'e. 'While the stretcher is thus supported, No. 1 descends. Al the Nos. now c:1rry the stretcher to the opposite side, and the foot of the stretcher is made to rest Oll the edge of the gronnd, while the head of the stretcher is sllpported 1>y.No. 1 in the ditcb. No. 2 climbs out, No. 3 remaiuing in the ditch to assist No. 1. 'rhe stretcher is lifted krward on the ground a1>oYe, and rests there while Nos. 1 and 3 climb up. The bearera then resume the carriage of the stretcher.

To CROSJ L ,VALL.

The stretcher is lowered with the foot about one pace from the wall. Nos. 2 and 3 bearers then take hold of the foot 01 thestret<.::her and No.1 of the head; the stretcher is raised till. Lhe foot is pln.cec.l on the wall. No. 2 then jumps over the wall and takes holJ of the Soot of the stretcher while Nos. 1 anu 3 support the

• These numbers are explained liJter in the detailed Stretcher Exercises.

18:;

head; the strcLc.:lier is then carried forward till tha head rests on tbe. wall, No. 2 Suppol'tin:; the foot. Nos. 1 and 3 then Jllmp over the wall and take hold the head of the stretcher, which is then slow! v lIfted the ,vall on to the ground, and the bearers take thelr usual places.

To LOAD A ,yAGOX.

th Theci'SlJ'etcher is lowered with the foot one nace frOl ' l f e t the wagon. Nos. 2 amI 3 take of 00 0 t e No. 1 the head. The stretcher is then ralsed and carried forward ti II the fron t l'est on the fl oo r of tht1 ,,"},o-Ol) "'o·J th • < (:). ."" ell Jumps mto the wagon, while No.3 goes to the head the stretcher and No. 1. The stretc:her en pLlshcd slowly llltO the wagon. If tIle tn.iJ cannot "?e shut, the stretcher mus t be lash ed llnly to the Sides of th.3 wagon.

To Ul'iLOAD A 'YAGOX.

os. 1 and 3 take hold of the head of the stretcher whtle No. 2 gets iuto the 'wagon; the stretcher i ' then gradually drawn out till the foot-wheels rest or the of the wagon. No. 2 jumps out of wagon and WiUl TO . 3 takes hold of the foot of tho stretcher, No. 1 supporting the head. The stretcher

IS5

h t' t

then gently drawn away one pace fro:n wag.on; and lowered. The bearers then fall m m theIr usual places.

When four bearers are attending to tepa len , Nos. 1 and 3 woulu lift the head of while Nos. 2 and 4 Jjft the foot. ThIS applIes to crossing a ditch or wall as well as to loadmg and unloading a wagon.

CHAPTER X. STRETCHER TRANSPORT.

BY SIR JOHN FURLEY.

FORMERLY the instruction gi ven to the classes 05 the St. John Ambulance Association, on the removal of sick and injured persons by stretchers 01' improvised methods of transport, bas been founded 011 rules laid down in Professor Longmore's" Treatise on the Trans.port of Sick and 'Younded. "

But it has been amply proved that rules necessary for drilled and disciplined bodies of mell, snch as the Royal Army Medical Corps, are not applicaule to those who undergo a brief training to enable them to givo first aid in the accidents of ci viI life. In the majority of cases in ,,,hich a certificated pupil is called upon to act, be has to look for assistance from men who have had no such instruction as he possesses, whereas every member of a military bearer company is drilled to work with others, and when three or four of such men ha\'e been numbered off, each knows what is expected of him.

The regular drill req.uired for a bearer company in the army is therefore not the best for a class 0·£ pup;ls of this Association, except in the case of a co rps wllich may be called 011 to act with a military hody.

On a parade ground or in a military hospital there

is generally plenty of space, and one system of lifting and carrying invalids can be adopted, but the.accidents which in civil life make it necessary that much should be left to the intelligence amI experience of th ose who llC."\.Ye to render first aid. For when a patient bas to be placed on a stretcher :n a cottage, in a factory crowded with machinery, or ill the tortllous passages of a mine, it would. be guite impossible to follow the directions given in the "Manual of Ex ercise for Stretcher Bearers and Bearer Companies," but the 8tretcher must be put at the :3 iclG of the patient or in any other positioll possible, p,nd the llearers must act accordingly, under the directioll of one of their party.

On this subject Professor Longmore has said : "The military rules \vere framed for service ill the open tLir, where there is, of course, plenty of space, but all such rules must be modified according to circum-

" It is well, I think, to teach the system which is thought to be best, and at the same time to preparc persons for doing that which is next best, when wha t may be best under other condit/ions ceases to be applicable."

For purposes of drill, numbering the bearers will be found. useful; whenever three or foul' mell thus instructed filld themsel yes in a position to work together, tbey will ad wit.h less besitatioll, less 137

liability to accident, with more speed; but in m ust repeated that 111 nearly all ordinary accidents, effiCient will bave to select his assistants wltho.ut prevIOus notice, and give them his directions as. bne.fly and clearly as he can. . most important P?lllt I to unders.tand the pnnc/,ples which have dIctated the rules laid down in the Exercises. It is l,lOt pretended thn.t these 'treteher Exercises will be to every. circumstance tlw,t may arise. 1 01 pln,Cll1g of a stretcher in a road-cart r.aI lway carnage must dJpend on the shape of the \ elllele, and perhaps on the wid tIl of a door. It would o.ccupy too mll ch space, and then, perhaps, the direc tlOns wOllld be fOLlll ri inadequate, were attempts made to plans for [1,1l case..:. It has been found by ex pCLcnce that those who take the trouble to attend the lectures and q llalify themsel yes for the certificate are illlly. able .to meet difficultie . as they arise. nstl uctOlS and pllplls may, ho",e\'e1', be reminded t hat, :rh.el1cycr l1?ccssary, stre.tchor issued by the ASS?CmtlO11 may oe lessened In wldth wiLhout incollvemence to a patient upon it.

"Furley." Stretc:hers 1899) are of tIllee patterns, VIZ., " Ordlllary " "Telescopic-bandIed" and "r I' " I' , < 0 Ice. 11 principal they aro alike, t he parts belllg dcsignated. the poleR, ha ndles, ]oluted traverse bars foot-wheels bed pillow sa ck and sli ngs. } "

The Ordinary Stretcher (Fig. 75), is 7 feet 9 inches in length, and 1 foot 10 inches wide. The bed is 6 feet in length, and the handles 10k inches. The foot-wheels raise the stretcher 4k inches from the ground. At the head of the stretcher is a canvas overlay (the pillow sack) which can be filled with straw, hay, clothing, etc., to form a pillow. The jointed traverse

FIG. 76.-TELESCOPIC-HANDLED STRETCHER-OPEN.

bars are provided with joints, so arranged as to guard against the possibility of the bearers catching their fingers in them when opening or closing the stretcher. The poles are rounded on the top, and have Inl inside bevel to add to the comfort of the patient and prevent cutting the canvas. The Telescopic-handled pattern (Fig. 76) is very similar, but is so arranged that the nandles can be slid underneath the poles, thus reducing

the length to 6 feet, the length of the bed being 5 feet 8 inches. This arrangement is of great value when working in confined spaces, or when a patient has to be taken up or down a narrow staircase with sharp turns. The Police stretcher is similar to the Ordinary pattern, but is more strongly made, and has, in addition, straps for securing a refractory patient.

'Vhen closed, the poles of the stretcher lie close together, the traverse b:us being bell t in wards, the canvas bed neatly folded on the top of the poles and held in position by the slings which are laid along the canvas, and secured by a strap placed transversely at the end of each sling being passed through the large loop of the other, round the poles and bed, and then buckled.

In closing a etretcher care should be taken to raise the centre ofthe C8'was when pushing in the tra,'erse bar, as it is otherwise liable to get caught in the joint of the traverse bar.

To prepare, or open, a stretcher, unbuckle the transverse straps of each sling j remove the slings from the stret0he1' j separate the poles j take hold of each traverse bar and draw it forward. The slinO's will then be folded to half their length, one laid neatly over the handles at each end of the stretcher.

As a general rule, the stretcher will be prepared by No.1 bearer in Exercises 1. and III. j by Nos. 1 and 2 in Exercise II.; and by No. 2 in Exercise IV. These

FIG. 75.-0RDINARY STRETCHER-CLOSED.

bearers will, however, if required, nssist the oth er benrers in to the patient's injuries.

No/e.-The y:uious movements detailed in the foliowinCT Exorcises shonld be carried out steadily, ihe bea;crs working in unison, hurrying being care· flllly ay-;-ided, and oyery attention bcin'g paid to the benrer whose duty it is to give the words of comman d.

STRETCHER EXERCI ES REVISED, 1897.

EXERCISE No. 1.

FOR TrmEE BEAREns.

1. The Instructor selects the bearers and numbers them - I, 2, 3, at his discretion. Should one man be tn.ller and stronO'er than tbe others, he should be styled N o.1, as he will have to bear the heavier part of the burden.-J;'

All orders will bo given by No . :\ who ,,,ill. look after the injured part of the patient's body or lImbs, to see that no bandages or splints l.... t;como displ aced, and a.]so that No. :3 bearer, in lifting or carrying the 8tretcher, does not touch the patient's feet.

• Bea.rers should, however, be taught to take any of the positions named in the following Exercises, whether that of No . I, 2', 3, or 4 bearer. '

2. "Place the Stretcher."

No. 1 the stretcher, and No. 2 the foot, place It m a h?e WIth the patient's body, the foot of the stretcher bemg close to his head.

3. "Fall I n.'' At this order,

IT o. 1 places himself at the patient's ri rd1t sieJe . No :3 nt hi s left side, and both bearers each other' .No. 3 position OIl the injured side, in a wIth tho pa tIent's kn ees .

4. "Ready."

Nos. 1 and :3 now each sink down on ono lmce and each other's hand s under the sh01llders and thlghs o.f the patient, "whilst Te. 3 n]"o kneels aml Ius underneath the lo'wer limb", tuk J])g m 0'1.Ee of a fracture, to have one hand on each Ide of the seat of injury.

5. "Lift."

All :tearers rise togetber to their feet, keeping the patlent lt1 a horizontal position.

G. " March.')

All take short. carrying the patient oyer stretcher untll hIS head is immediately above the Idlo\\, .

7 "Halt."

All three bearers 1'ema;n steady.

8. "Lower."

The bearers stoop down, gently place the patient on the stretcher, disengage their hands, and then stand up .

9. " Fall In ." On this order being given,

No.1 places himself at the head or the stretch er "'ith his race towJrds the patient, No. 2 at the with his back to the patient, and No.3 places himself at the side or the patient.

10. "Ready."

Nos. 1 and place the slings (if used) over their shOlllders, stoop down, and slip the loops of the slin gs on to the handles of the stretcher, which they the n grasp.

As soon as all is right the word is gi vel1-

11. "Lift."

At this 'word, Nos. 1 and 2 bearers raise th e stretcher steadily together and stand up.

No . 3 will now adjust the slings on the shoulders of Nos. 1 and 2, ta.king care that each is well below the level of the collar, and lies accurately in the hollow ef the shoulder in front. He will also lengthen or shorten the slings. having regard to the patient's in] uries and the relati ve heights of the bearers.

12. "March." On this word being given, Nos. 1 and 3 step off with the left foot, and N o.2 with th.e right. The step should be a short one of

twenty inches, :1.nd taken with bent I· -. should b . f moe;:,. The re e no spnng rom the f01'e part of lhe foot.

13, " Halt, "

t l ueing reached. on the \yord " naJ t 1e carers remalll steady in position. !

14. "L ower."

At tbis order the bearers place the stret h on the . d r c e1' LTcntlr h gIOun , !: lp the loops of the slino's oOfr t I ' 'handlldes of the stretcher, remove tbe slinD's °from s ou ers and ih t cl. 0 III. let the 't' t' ;n s an 11p j care being taken to pa len s eet reach the ground l>cfol'c

lB . "Unload Stretcher-Ready.»

_ Th e bearers prepare to take the patIent fT h bt1'e t chel', as at Orders 3 llllcl. 4. ,) t e

IG. "Lift."

The rai se the patient ," S PI cal I 0 ,,, " Order 5, an d c T}' 11111. Y short side step'. cleul' of the the ocd, 01' other place to it een allanged to convey him,

17. "Lower."

The patient is carefully lowered.

o

EXERCISE No. II.

FOR FOUR BEAUEUS.

1. Number the bearers-I, 2,3, 4. All orders will be gi yen by No.4.

2. "Fa11 In."

At the words" Fall in," Nos. 1, 2, and 3 take position on one side of and facing the patient. No . 1 places himself at the patient's shoulder, No.2 near the middle of the body, No.3 near the patient's feet. At the same time No.4 places the stretcher on tho ground by the other side of the patient, about two pnc es a\yay from him, and then takes position opposite to and facing No .2.

3. " Ready."

rrhe bearers kneel down on the right knee if they arc on the left side of the patient, on the left knee if ehey are on the right side of the patient. They then proceed to take hold of the patient :-Na 1 passes one of his arms beneath the patient's shoulder-blades and the other across his body aIld under the opposite annpit, except when the pati,ent's injuries make thi s impractioo,ble, in whieh case both arm,s should be placed under the patient's shoulders j No. 2 passes 10th arms under the middle of his body, one abov e, the other below the buttockslj and TO. 3 passing bot!l

195

arms uuder the lower extremiti t k' . case of fracture to place es, a mg care, 111 the b' k b ' one allll on each side of the 10 en one, so as to steady it T 41 k . with No.2 under the 'tSh hIs be able to help, he should clasp his' h -l e patIent neck of No. 1. anli'3 rOllnd the

4. "Lift."

On the wmd "Lift, " the bearer .' . gently and re st him on the knees e t]he,/atJdent bearers' as " l' 1. as. ,oJ, an 3 ) ,_can ns 1e IS Eecurely rest d 4 l' C'ngages halJds " .jth N 0 e, o. C ISthe t. t h ' o. :-" rllns round by the head of the .under the patient, close to ., c ,€mg careful that the '11 IS Immediately ullCler the patient's I plOW down and locks his hands

5. "Lower."

stretcher, dis-

6. "Stand to Stretcher."

r; 0 1 goes to the head of tl' . face towards the patient. N 9,1e stl etcher, ,nth his b.ack to the patientj th,e foo.t, with his of the stretcher N 3 I ' 4 I all each No.4. ' o. p aCIng hI mself opposite o 2

7. " R eady."

197

11. " Low er."

.

N 0S. 1 a.ud 2 place the (if used) over shouluers stoop down, a.nd slip the 100p3 o£ the shngs on to handles of the stretcher, which they then grt\sp. . .

A 80)11 a.'3 a.ll is right the word IS gl ven. ,( L ift."

At this word, .J.. os. 1 a.nd 2 bea.rers raise the stretcher steadily together a.nd stand up.

.J,.Yote -Nos. 3 and 4: will now adjust the dings the of Nos. 1 and 2, taking i.h::Lt each well below the level of the eollar and hes m the hollow of the shoulder in front. . rhey wlII also lew!then or shorten the slings, h.avwg J.-egard to the p::Ltient's injuries and the relatIve hClghts of the ue:11'e1's.

D. "March."

The bearers moye off :-Nos. 1, 3, and 4 stepping off with their left foot, and No.2 with his . right foo t. The step should be a short Olle of twenty l::ches, w.ken with 11ent knees. There should lJe no spnng from part of the foot.

10 . "Halt."

The destination beino' reached, on the word " Halt " being giYen, the bearel; remain steady in position. _

At this order the bearers place the st)'etchel' gently 011 the ground, slip the loops of the slings off tlte handles of the sUetcher remove the slings from tllC' shoulders, and then stand up; cne being taken t:) let the patient's feet reach the grouucl beforc his head.

12. "Unload Stretcher-Ready."

The bearers prepare to take the patient off the stretcher, as a.t Orders 2 and 3.

13. "Lirt."

The bearers raise the patient as a.t Order 4:; No.4, in this case, disengages hands from No . 2, remOye8 stretcher, and resumes his former po::;ition. If sary, the bearers will then steadily rise together, anci carefully carry the patient to the vehicle, bed, or other place to which it has been arranged to con ycy him.

14. "Lower."

The patient is carefully lowered.

EXERCISE No. III.

WHEN THREE BEARERS ARE AVAILABLE AKD THE STRETCHER CAKNOT BE PLACED AS IX EXEIlCISE I.

1. The Instructor numbers the bearers-I, 3.

All orders ,,·ill be giyen by TO. 3.

2. "Place Stretcher. "

No. 1 bearer places the stretcher on the ground b.y the side of the patient, and as close to him as practicable.

3. "Fall In. ''

The t lll'ee bearers take the same positions on one siJe of the patient, as laid down in Exercise J o. II.

4. "Ready."

Nos. 1, 2, and 3 kneel down) placing themselves as close to the patient as they conveniently can, and then take hold or him as directed in Exercise No . II.

5. "Lift."

Nos. 1 2 amI 3 raise the patient as directed in Exercise No: II., and then mo"\"e in a kneeling position up to the stretcher.

6 "Lower.»

The bear8ll's bend forward) can.f ull y lower the pa.tient on to the stretcher, and disengage hands.199

7. "Stand to Stretcher."

At this direction all the bearers stand up; No. 1 goes to the head of the stretcher, No. 2 to the foot, and No. 3 remains in position at the side of the stretcher.

. " Ready. "

Nos. 1 and 2 place tbe sling3 (if used) oyer their shoulders, stoop down, and slip the loops of the slings on to the handle.:; of the stretcher, which they then grasp.

As soon as all is right the \VorLl is given-

9. "L ift."

Nos. 1 and 2 b3arers raise the stretcher steadily gether and stand up.

No.3 will now atljnst the slings on the shoulders of Nos. 1 and 2, taking care that eJ.ch is ",;11 below the level of the collar, und lies accurately in the hollow of the shoulder in front. He will also lengthen or shorten the slings, having regard to the injurie.:; and the rehtive of the bearer.:;.

10. "March."

K os. 1 and 3 step off with the ldt foot, and No. 2 with the right. The step should be a short one of twenty inches, and taken with bent knees. There should be no spring from the fore part of the foot.

20)

11 . " Ha l t ."

The destination being reached, on the word" Halt,7i the bearers remain steady in position.

1:3. " Lowe r."

At this order the bearers place the stretcher gently on the ground, slip the loops of the slings off' the nandles of the stretcher, remove the slings from the shoulders, and then stand up; care being takf'n to let the patient's feet reach the ground before his llead.

13. " U nl o ad Stretcher-Ready."

No.1 places himself at tho patient's right side. No. 2 at his left side, and both bearers faco each other.

No.3 takes position-on the injured side, in a line with the patient's knees.

Nos. 1 and 2 now each sink down on one knee and grasp each other't; hands under t.ho shoulders and thighs of the patient, whilst No. 3 also kneols and places his hands underneath the lowor limbs, ahyays takinb care, in case of a fracturo, to h::!.Ye one hand ou each side of the scat of mjury.

1-L " Lift."

The bearers raise the as at Order 5, and (,;•• 1 ry him by short side steps, clear of the stretcher, 20]

to the ychicle, bed, or othel' place to which it has boon arrangol to convey him

15. " Lo wer."

The patient is carefully lowered.

EXERCISE IV.

FOR USE MrKES AND NARROW CUTTfXGS, WIIERE Two MEN DE EXG,I,.OED.

Necessary First Aid haying been gi\'en, Nos. 1 and 2 will carefully place the stretcher ill n. lillo with the injured man's body. the foot of the stretcher being if possible, * close to his heau. '

. No. l.":ill give the word" Ready," whell oath get mto posltlOn as follo\\s :-

No.1 pI.aces his feet one on each sid8 of the patient between IllS body and arms, the toe of each foot as near the armpits as possible, standing' oyer the man. He thep stoops down and passes his hands between

It is not uch'isable to bc too p3.rLi('uhr as to the head or of. a stretcher in. a minc? it ,would probably be quite Imposslble to reverse 1 t. amI 1 IS a.wa,ys competent for the l.:le3.rers to lower the pillow.

20'2

the sides of the chest and the arms underneath the shoulders, and locks the fingers.

If the patient's arms be uninjured he may put them round the neck of No. I, and by this means greatly assist him in lifting.

No.2 at the same time places his right foot between the cahes of the injured man's legs, as close to the knees as possible, and his left foot at the injured man's right side, close to th e crest or the hip;;"< he then stoops down and passes hit; arms round the outside of the patient's thighs at the lo,,-est part, and locks his fingers behind just at the bend of the knees. ,Vh en both are ready, No. 1 will giye the order " Lift and Inove forward." The patient is then to be slowly lifted just sufficiently to allow his body to clear the stretcher. Both bearers ,,-ill slo\vly and gradnally moye fOf\yard, No.1 by very short steps, and No.2 by bending his body forward oyer his left thigh, by which means he exercises a pushing moyement which yery greatly assists No.1. No.2, \"hen he has bent his body forward as much as he can without moving his feet, advances his right foot to his left, then again advances his left foot, and bends his body forward. This movement is to be repeated until the patien t is laid all the stretcher.

.' * V\'hen the patient's legs are in splints ::Ind tied together, feet of No.2 must necessarily be placed outside.

203

The bearers will then act in the Oldinary mallner as far as the nature of the locality will permit.

The Ashford Litter (Fig. 77) is made np of either of the Furley stretchers mentioned 011 p:l3'e 187, a

FIG. 77. wheeled and a waterproof hood and apron, or, If a light wet-resisting canvas cover. The stretcher IS kept in position on the under-

carriage by tn, toot-"'heels, \ybich fit mto slots in the sides of the under-carriage, and it can be removed at pleasure. The nnder-carriage is fitted with a ?mnked axle, which allows the bearers to pass wIth the stretcher between the wheels instead of lifting it over them. At both ends are two legs itted with automatic self-locking hing€s which al10w the legs to be turned up as h:111dles when wheeling th0 litter, and securely lock them eitber as legs or handles.

The hood and apron fit into sockets screwed to the stretcher. In "'heeling the litter, care should be taken to keep the patient in a horizont al position.. A new and further improyed pattern under-carnage has recently be-;-n introduced, having the two legs on each side coupled, so that wben one is raised or lowered that on the same side at the other end of the undercarriage is also mised or lowered. Should it be necessary, t\yO bearers can easily lift the litter and patient. 205 CIIAPTER XI.

(Bei g the Fifth Lectu1'efcT Females enly, ,'n acco1'dance with 8y:Zoo mls 58.)

flY

FOR RECEPTION OF AcclDENT CASES.

'VH EN news of an accident cemeR, preparations at once ue made w n.' to bave eyerythilJg rcady Lcful e tbe inj tued person i ' LrOtlglJt in. Of course the JIn:parations lleedful ,\'ill \ aly accOlding to the nature and extent of the injllly, but the following are the chief things \\'lJich nwy baye to be dOlle.

Cnor CE A0D OF ROOM.

A room must be eho en. In a bad case this bhoulo. Le one easily reacbed, as it is diilic:uJ t to carry an injured l)crsou through narrow pass[1gcs and IIp-siairs . U nle::'8 thcre is E.ome llch 1 C[.SOll against it, the injured perboll's own ream is Lest.

The way to the room must ue cleared, projecting furnitur e and loose mats ill the ball or in 10Luies should be removcd. If t I:e inj meo. persall is earrieo. on a dovr cr Ell lIltcl', or eyc:n 011 a stretcher, a couple of strong kitd.len chairs sho ulo. be placeo. rcady to

E. MACDOWEL CG GRAVE, :M.D., F.RC.P.T.

support it, where yer the bearers would be likely to r equire rest..

Useless furniture should be removed from the bedroom, rrhe bed should be drawn out from the wall ;;0 that both sides can be approached, and the clothes turned back to one side to their full length. A hot bottle should be got ready. If there is much several hot bottles and hot blankets may be reqmred ; coyer the hot bottles with flannel.

If the injury is very severe, clothes have to be removed, or if extensIve dressmgs have to be applied, it may be necessary to ha\e another bed, a couch, 01' a table placed n ear the ,bed to lay the sufferer on in the first instan ce. ThIS should be so arrano'ed that soiling may do no harm; old sheets, wa.te12roof materials, thin or eyen newspaper, may be used as a protectIOn.

A1\D

If present at the place wh ere the it will be necessary to see that the patIent IS carefully lifted after proper "First Ajd" has been rendered.

The follow ing rules should be remembered: - Select the proper number of perso,ns to assist, and do not le.t them lift the patient untIl Lohey thoroughly undelstand how they are to do it,

207

For ordinary cases, where 1;he injured person has to be .lifted a very short diEtdnce, three helpers are suffiCIent. .Two (who should be as far as possible of equal heJght) are to bear the weight, the third is to support and take charge of the injured part. This is best done by a person who has been through a " First .Aid)) course.

If the injured person is insensible, another helper should support his head.

The lifters, one at each side, should kneel on one knee, and pass their bands under the patient's back at the 10wE:r part of tbe shoulder-blades, and under the hips, clasping each his right hand in the other's left. The injured patient should, if practicable, place his arms round the necks of th0 bearers.

. helper should attend to the seat of injury j Jf thIS IS a fractured limb, he should support it by placing the palms of his h:1.l1ds under the limb, one and one below the seat of the injury, grasping It firmly but avoirliug unnecessary pressure.

The helpers should r emain thus until the order " Lift" is gi\'en, and then they should all lift slowly and steadily, avoiding jars, attempts to change position of hands, etc.

,> If the inj m ed person is to be placed on. a stretcher or shutter, this should be previously placed with the bottom end at his head; the bearers should then move, one at each side of it, until the patient is over

it. The word "Lower" should then be given, and the injured person should then be slowly lowered. A pillow or folded-up coat should be ready, and as the suffer er is lowered, this should be pln.ceJ. under his head.>\<

OF CARRYING.

Besides::;, stretcher, and substitutes such as a gate, a shutter, or a door, other means of carrying can be i:u provised.

In &light injuries, where the injured person is ullaLle to walk, two bearers can carry him by forming a fourbanded, three-handed, or two-banded seat.

A four-ha n ded seat is formed as descl'iueu on page 171.

A three-h an ded sea t is made as described 011 176.

The two- han ded sea t is made as dcscriueu on page 174.

A single help er can lift by supporting \rith one arm the two knees, and with the other the back. Th e arms mllst be passed well under before commencing to lift.

A single help er can give support by putting his right arm round the waist, grasping the right hips and placing the inj ured person's arm round his own neck, holding the left hand with his OWll left hand.

• Full directions are given in Chapter x..

209

A capital stretcher can be improviseu ont of a strong sheet and two broom handles or other short poles. Each side of the sheet is wound up on a broom handle until there is just room for a person to lie between. This requires four bearers two at each side to prevent the sheet slipping.' ,

CARRYI TG UP TAIRS.

In carrying a stretcher up stairs the head should go first, and an extra helper should as ist at the lower end, so as to raise it and keep tr_e stretcher nearly horizontal.

The two, three, or four-handed seat may be used for up stairs; or a strong chair, the patient being earned up backwards. In the latter case one helper should walk after the chair and help to support it, and to prevent the illjured person slipping out.

INTO BED.

If the bed is narrow and there is room the stretcher should be IJlaced on the floor with the head close to the foot of the bed. The injured person should then be lifted over the foot and placed on the bed . If the bed is too wide to admit of this, the stretcher should be placed beside it, and two helpers should stand at the far side of the stretcher. . One bel per passes one p

210

arm beneath the sboulders and one beneath the middle of the back, the other helper placing his under the lower part or the back and under the knees. The injured person is then lifted, another helper pulls avyay the stretcher, and after a single step forward the ...burden is placed on the bed.

PREPARATIOX OF BED.

A firm mattress, not a feather bed, should be selected. If there is much injury, or if dressings have to be applied, a draw-sheet ought to be placed on the bed. It should be of four or more thicknesses, extend across the bed, and reach from the middle of the patient's back to the knees. A piece of waterproof sheeting or of thin oil-cloth should be placed under the draw-sheet. As the draw-sheet becomes soiled, the soiled portion should be roll ed up and ;). clean part drawn smoothly under the patient..

'In fraeture of the leg or thigh, sprained ankle, and some other cases, a "cradle" should be improvised. The use of a " cradle" is to support the bed-clothes and keep them from pressing on the limb. Bandboxes, three-jegged stools, and similar articles may be used. A corkscrew passed through the bed-clothes with its point guarded by a cork, and tied by string to the bed or a nail in the wall, will relieve the pressure of the bed-clothes effectually. .;;

211

REMOVING TIlE CLOTHES

injured person a few ru1eli

In serious cases it is 'much b clothes than to run ' .' k otter. to sacrifice theinjury. any 11S of Increasing

In remoyin ()" a coat etc . th " '" "J In a case of fract . d e ul1lnJured arm should b d. me a1'n. I t' e laWn out first 11 put mg OE anythinO' th .. . be put in first. I::> e InJ ured arm 8houlo

In burns and scalds no h ' draO'ged off \ .1;. . t mg should eyer be b Il. i} La? P pall' of scisso' I and eyel')'thilw not adhe" h lIS s lOuld be used r If I"" Ilng s ou d be . anyt ling adheres it should b ?ut away . aId can be obtained Tb ] e h. left un tIl medical . . . e C ot lUg dh . 'nth ad \'u,utage, be soaked with oi1 enng maY r trouser::; from a severedy " 1' '10 re1110ye the Sep111 should b .' d ll)Jureu limo, the outside e llppe up.

PREPARATIONS FOR SURGEON.

As soon a.s the inJ' ured person 1 to las been .. preparatIOn be mad \.l VISIt. e for the surgeon's

The preparations df I nature of the case. nee II depend upon the The follOWIng hints may be of

212

A fire in the room will generally be of sorvice, even in summer. There should be plenty of water, both hot and cold, also several basins, plenty of clean towels and soap. There should be something to empty water into; a foot-bath docs well. 1'1e basins should be placed on a table, covered with a clean ,vhite cloth; a large towel makes a suitable cloth; the towels, folded up, shoLlld be placed on the table, and tbe hot and cold water should be "' ithin easy reach. The foot-bath should be under the table or close at hand.

In the case of a burn, cotton 'wadding, soft cloths, old linen, oil, flour, bread, and bicarbonate of soda (baking soda) should be ready, and materials should be torn up for bandages. If a c.:hemist's shop is within reach, cal':!."on oil Rnd }Jlenty of cotton wool Euould be sent for.

[n the case of hromorrhage, sponges, plenty of \..... ter, and at least two basins should be reauy.

In the case of a person rescued from drowning the sileets should be taken off the bed, plenty of blankets should be heated \)cfore the fire, and several hot bottles should be ready.

If poultices are likely to be required, boiling water, linseed-meal, mustard, a loaf of stale bread, a small basin, a large spoon, sweet oil, and tow, flannel or handkerchiefs may be required.

213

For fomentation h;"e b T kitchen roller and two st' 1 01 mg water, flannel, a vYh '. Ie (s, or a large towel en summODlnO' a medic 1 . always let bim what kin: ofman to accident to treat so th. t h . case he IS required 13 ' a e may brIllO' what . y this means valuable time 0 b ever IS needful, may e saved.

INDEX. Page

J.bdomen ... 161

Accident cases. preparation for '" 205

Acids, poisoning by ... 154

Alcohol, poisoning by ... 152

Alkalies, poisoning by ... 154

Ammonia, ,... poisoning by... ... . •• 154

Anatomy 19

Ankle, 8praineL 1 ••• 68

Anterior tibial artery... 97

Antimony, poisoning by 155

Aorta 73,82

Apoplexy 113 _ )) to distinguish trom collapse from drink 116

Apparently drowned, to restore .. 146

Aqua fortis, poisoning by ... 154

Arm, bleeding from 91, 92 " bone of .. 26 " fracture of '" 54

Armpit, bleeding from.. 92

Arsenic, poisoning by ... 155

Arteria.l hremorrhage ... 76

., " general principles of arrest of I I

Arteries ._ 70, ':'2

Pags

Arteries, course of the main ... 82, 85, 96

Artery, axillary 86 brachial 86 carotid ... 82 digitl'll ... 87 dorsal... 97 facial 84 femora1... 96 iliac 82 plantar... 0'" 9G radl<l... 8a subeL·v-!':l!': 85 t:!t;;a.! 97 " uina: 86 Artificial reerJiratlOl' :.*1 Atlas - 21

Auricles... 70

Axillary artery... 86 21 l:).'1.ck, bandage for 169 Bac\bone 21 to fasten 40

Bandag(ls 38

Banda;(ing 165

Bed, preparation or 210

Belladonna, poisoning by 153

Bites ot animals... .., 134

Page

Bladder ... 164

Blood ... ... ... 73

Bones, general description of... ... ... 20

Brachial artery... 86

Brain digital compression of " concussion of Breastbone , , fracture of '"

Breathing, stertorous ...

Broad bandage ... __ Broken bones, see Fracture.

arteries ' 82 wound of 83

Carrying, means ()f . ., 208 " patients 171 "upstairs 209

Cerebro-spinal system ... 10.3 Cheek, bleeding from ,.. 84 Chest ... ... . .. 159 " bandage for 168 Chlorodyne, poisoning by 152

poisons

Dit<;h, to cross with stretcher ."

Dorsal artery of foot ::: g,

Dress, woman'g, on fire 133

Drink, collapse from ... 114

Drowning 146

E:lr· channel, bleeding from 85

Ear-passage, foreign body in ... ... 158

El:.tstic bandage tourniquet 81

Elbow 170

Elbow, bleeding from bend of 91

Elbow joint 31

Electric shock 121

Emetics 150 " cautionastogiving 155

Epilepsy... ... ... 116

Esmarch triangular b andage 38

Expiration 140 Eye 157

U'ace

Facial artery, to compress ...

Fainting ...

Femoral artery... ., . " "digital compression of ...

Femoral artery, to apply tourniqnet to ...

216

Femur " fracture of Fibula 24 84 118 96 99 100 29 59 29

Fibula, fracture of Field tourniquet ."

Finger, bleecting from .. . Finger bone, fracture of Fireman's lift ... First aid, meaning of Flexion of limb ... Foot, bandage for bleeding from " bones of .. , " crushed

Forearm, bleeding " bones of from 91 27 56 166 84 " fracture of .. , Forehead, bandage for. .. " b leeding from Foreign body in the ear passage ... Foreign body in the eye nose se;t

Fracture, '.lpparatus for treatment of ...

Fracture, causcs of definition of... general rules for treatment ). ) of arm of bones of foot of breastbone of collar-bone of fing er b('ll1e of forearn

of knee cap ... 62 of leg '" 64 of lower jaw.. 48 of met::lCarpus 58 Of peins 59 of ribs 49 of shoulder· blade 54 of skull . .. 47 of spine .

46 of bone 59 signs and symptom. of 37 varieties of . .. 35 Frostbite 129 Ganglia ... ... Oreen-stiC'k fracture

wounds arrest of

internal Ham, bleedincr from Hanel, b Lodage for bleeding from

218 Page

Laburnum seeds, poisoning by... ... ... 153

Lacerated wounds 127

Large arm-sling... 42

Larynx...... 138

Laudanam, poisoning by 1[;2

Lead, poisoning by ... 155

Leg, bleeding from 98

" bones of 29 , fracture of... 64

Lifting and carrying 206

Lifting into bed... 209

Lightning, effects of 122

Lime (quick), poisoning by '"

Lips, bleeding from

Needle, a broken Nerves ...

Nervous system ...

Nose, bleeding from Page 129 105 105

" foreign body in ... 85 159

Oil of vitriol, poisoning by ... 154

Opium, poisoning by ... 152

Palate, bleeding from... 84

Pallllar arches ':37

" " bleeding from 87

Paregoric, poisoning by 152

Fa(Je

ro.tash, caustic, poison- . mg by... ." ". 154 for surgeon 211

PrussIc aCId, poisonincr by 0 r b ... u es 27

Pulse ". .. . 75

Pllnctured wounds ' 1'>7

Pu piIs . " .. . ... l(i9

animals, bites of 134

219 S Page houlder, h'lnrldge for ... J66 " blade '" 25' .. fracture of 54 joint '" 31 o..:Jckroom, choice and .prepa ration of 205 SImple fracture... 35 :-- kplctoD ... 20

123 " wounds of... 123

Litter, Ashford .. 154 84 20:3 ]6,}

Patella ... 29

" fractme of 62

Pelvis 27

Liver

Lungs 138, 159

Mercury, poisoning by ... 154

Metacarpus ... ... 27 " fradure of ... 58

Metatarsal bones, fracture of 65

Metatarsus 30

Metallic poisons 155

Middle line of body 20

Morphia, poisoning by 152

Muscles... .•. ... 31

Mmcular action 34

Narcotic poisons 152

N arrow bandage 38

" fracture of flU

Phalanges '27, 30

Pharynx ... 138

Phosphorus, poisonine, by ] 55

Physiology 19

Plantar aI·teries 97

Plants, various, poisoning by... 153

Poisoned wounds 128

Poisoning, directions for treatment of ... 149

Poisons and poisoning 149 classjfication of 152 with double action... 156

Popliteal artery 96

Posteriol' tibial art er."' . _. 97

RadIal artery ... 86 88 ., " bleedmg from' 89 Radius... ." ." 27 " fracture of 57

Respiration. artificial'" 14t

Respiratory system ... 13S Ribs 24 " of '" 49

Rump-bone 22 Rupture '" ]64

Sacrum .. . Scalds .. . Scalp, bandage £;1' " bleedillg from Scapula... '" " fracture of Seats '" Screw. Shin-bone Shock ... ... Shock, electric Shoulde:- ... 22 ]30 ]65 8-l 25 54 171 81 29 ] )0 12l 25

.. of" S:ings '" 42 arm-sliner '" 43 Snake-bite 0'" 135 Soch, c:mstic by... ' 154Spleen '" 163 Spinal cana.l 21 cord 105 Spi'ne . - '" 21 Spino, fracture of 46 Splint, aLgular '" 56 ." 38 " to ... 68 Sternum 25 " of 51 Stinb'l of insects, &c. 137 Stomach 162

p,Jge

Stretcher, Furley 187 to cJ.rry 181 .. " to prepare ... 180 to make a temporary " transport

Strychnine, poisuning by Rtunning ...

Styptic .. , .,. artery

" "digital compression of Suffocation by smoke or gases .. , Suffocation by swallowing vtry hot water ...

Sunstroke

Surgeon's visit, pre parati0n for

Sylvester's method of artificial respiration ...

Sympathetic system

Syncope ...

Tail-bone 22

Tarsus 29

rremple. bleeding from 8:3

Thigh-hone ._ ... 29 " fracture of .. . 59

Thorax 159

Three-handed seat 176

Tibia 2q

" fracture of 64

Trachea .,. H8

Page

Tbro:1t, bleed.ing from inside of 84

Tongue, bleeding from 84

Tonsi.is, bleeding from... 84

Tourniquet 79

Two-handed seat 174

Ulm 27 fracture of 57

Ulnar artery 86,88 " "bleeding from 89

Unconsciousness 107

Varicose veins ...

Veins

Venous hremorrhage

Ventricles

Vertebra ...

Vertebrre, cervical dorsal lumb::tr

V ertebral column

Vitriol throwing

Voic'\ box

Volunta.ry muscLs

Wagon, to 10J.cl and unload 183

Wall, to cros, with stretcher 182

Wind-pipe .. . 138

vVound of abdom 'n 161

Wound of lung ... 160

'""unda ... 124

St. Jobn tlmbulance Bssociation.

GENERAL PRICE LIST.

INTRODUCTION.

This Price Lis';, which is subject to revision from time to time, has been compiled with a view to assist members of the Association and others in the purchase of the necessary equipment for corps and divisions of the St. John Ambulance Brigade, ambulance sta tions, classes, and tirE:t aid a nd nursing work generally.

A complete and reliable Ambulance Equipment is an actual necessity, and experience has proved that employers of labour and others interested in the district readily subscribe for the purchase of such appliances. Collecting cards. stating the purposes for which subscriptions are J'equired, will be supplied gratuitously on application to the Head Office of the Association, where also any information with regard to its work C:1n be obtained.

Stores of the value of lOs. or upwards will be sent c:trriage paid to any part of the United Kingdom. "-:

Owing to the great and continuing advance in prices it is impossible to guarantee that the quotations herein cJ.n be adhered t::>.

Quotations will be furnished for Articles relating to Ambulance Nursing and Hygiene, not mentioned in this list.

Orders arcl correspondence should be addrcssed to the St. John Ambulance Associa.·tion, St. John's Gate, Clerkenwell, London, E.O.

Remittances should be made payable to the, t. John Ambulance Association and crossed "London and. Bank, Lothbury."

PRICE LIST

HORSE AMBUL,ANCE CARRIAGES AND WAGONS.

The St. John A mh nbnce Association CarriaO'es and .are. now so universally adopted that little d eSCrIptIOn I S need ed.

..,;I '1'he pri ce of th ese varies, a.ccording to size and fittings from £50 the li ghtest and simplest form to £150 for -elegant omn ib us, which is fitted for the use of an invalid or for ordinarl purposes of a family at home or abroad. PartlCulars! est.lmates, and list of places supplied will b. sent on applIcatIon.

PRICE LIST . ASHFORD -LITTERS.

The " Ashford" Litter consists of a two -w heeled l,ndercarriage fitted with elliptical springs, a,nd either of the " Furley " stretchers, with a, cover so arranged on a jointed frame that it {lan be folded up inside the stretcher , or with a hood and apron (see page 6). The under-carriage having a cra,nked uxle, the bearers can pass betw een the wheels with t he stretcher, and thus avoid lifting it over them . ·W hen travelling, the l egs of the under-carriage are raised, and t h us : orm the handles by which to propel it . Should it be necessary to pass e ver rough ground, two bearers c:m easily lift the li tter an d patien t .

The imp rovements in the" A shford " Litter (1 899 models) include all those in the stretchers men t ioned on 7, and r elate also to t he mechanism ofthe combined lege and handles, whi ch can now, by Oile movement only, be instantaneou sly ralseu or low ered , and fi xed wit h abso lute securi ty in t he p roper position. The appearance of the lit t er is enhanced ,and all foul ing of the stretcher with the handles of t he und er-carriage is avoided. For Prices see page 5.

PRICES OF THE IMPROVED ASHFORD LITTER, 1899 MODEL, Without New Coupling Arrangement. With Iron Tyres to Wheels. With India-rubb er Tyres t o Wheels_ W;thout I I With I With Oover or With With Hood and Hood and Oover Hood and Hood aud Oover. Apron. Apron. Apron. Apron.

Under-oarriage (no Stretoher)

Litter oomplete, with Ordinary Stretoher·

Litter oom-olete with Telesoopio-handled Stretcher t

Litter complete, with Polioe Stretoher t

• Prices quoted for Litter with urdinary Stretoher inolude Wide Webbing Slings, but no Ohest Strap. Leather instead of Webbing Slings, 5s 6d. extra. Ohest Strap, Is vd. extra If supplied without any Slings, 4s.

t Prices quoted for Litter with Telesoopio·bandled StretoheJ' include Wide Webbing Slings :lnd Ohest Strap. Leather instead of Webbing Slings, 5s. 6d extra. If supplied without any Blings, 48. allowed, aud if without Obest Stmp, Is. 6d. allowed.

t P)'ices q-:i ted for Litter with Police Stretoher inolude Wido Webbing Slings, and Leather Straps for scouring a refractory patient. Leather instead of Webbing Slings, 5s. 6d. extra.

Extra to a ny p a tte rn l itte r or under-carri a g e. Couplin g arrangeo a s describe d on p r l;.·,iou s page £1 10:3 Ud

SPECIAL HOO D AND APRO N.

The Hood and Apron illustrated ab ove have beer. iLtrvllL:l..e t to take the place of the co\-er sometimes as rart of the" Ashford" L itter, and [lfford mnch greater comfort to patient. T he material of which they are mude has LecL specially selected on account of its strEngth and waterproof qualities. They can be fittc(1 to any" Fu rley " Stretcher or f( Ashford" L itter. Complete cxha se t3 Df g-cti:ets and studs (>&'n 1e supplied at D nomina l ccst.

PRICE.

Hood a n d Apron, complete

Extra Sock et'! :;I,lld Studs, pei ",::(j

Waterproof S}led (washable) to be biJ on the

Rt retchc:'

PRICE LIST.

"FURLEY STRETCHERS WITH THE LATEST IMPROVEMENTS . I 899 MODELS.

TELESC:)PIC·H I:S-DLED STRETCUER-OPE);,.

ORDIC\ARl" STRETCfIER-CLO:'ED.

The Improvements in ::-.11 patterns of the "Furley" Stretcher, 1899 Model, are numerous. The comfort to the patient is increased; the stretcher is stronger, lUore rigid and lighter, it folds up more closely, and its handles are comfortable to hoB, and afford greater protection to the hands )f the bearers in passing through narrow doonnlys or passaaes. Should i t be necessary to reduce the willth of a loaded stretcher in order, fol' example, to carry it into a rai l . '\omy carriage, this can be done, either whG;i. i': b restinO' on the ground or supported by the be:lrers, wii'lllOli.t tronbleoand without the slightest jar to the patient. Th0 price of the stretchers is lowered. All minor points 11;]\-e been most carefully considered , a!lcl the stretchers a·re confidently 1'eC0111menuod as thoro ughly efficient in every ,my. -

These stretchers are Qchpted for use alon e or p",rt of the" Ashford." Litter, cove!', hOGJ and ap: on, army r ug, and specIal rLlg Wlth all' cuslllon and waterprvd dCRcribrd in this list, arc suitable for usc Wit'l tb)'.U.

Ordin and pillc and Telesc for

OF THE" FURLEY" STRETCHERS, WITH THE LATEST IMPROVEMENTS (1899 MODELS).

N .B.-Tho prices of thc Standar d Models aro shown in h eavy type.

With Wide With Wide With With Without Wehbing Webbing Leatlicr L ealht:r Slings 01' Slings S11ngs Slings Slings and Ohest Stmp. (uo Ohest and Ohest (no Obt'st Webblug Strap). Strap. Strap). Chest Strap.

Stretch er, for Generu.l £

use, taking the B of oth the old ordinary

military patterns

opic handled filtretcher, working in confined

P olice Stretcher, very str ong, with Ash Poles, nnd provined

with Le'Lther Straps to secnre a refractory patientOomplete, with Wide Webbing Slings

" "Leather Slings

Slings, Wide WetJbing

Do. Leather

(Or if pnrchased with thc Stretcher instead of WclJbill!; Slin gs, 5/0 extra).

Cover for Str etcher u 15 0

Hood and Apron (5 80 must1'atio7L, l?aye 6)...

Spare Bed for Stretcl'iel'

Army Rug, to cover patient on Stretcher

LAMP.

Tliis is fitted with (t socket by "llich to fix it to the Ashford Littu, or it I'an be cOlweniC'ntly eaIried oy hand, or attached to a belt or the clothing.

1'1'ice complete, 5s. Cel.

Dressing Basin, kidney-shaped, made ()f enamelled 1ron, Price Is. 3d.

Knife, with Strong Blade Pair of Scissors ... '" each 9el. ; per doz. 88. each Is. ; per (l(,z. ) lis.

Carrying .sheet for carrying patients up and down stairs or othenl ise about a house. Designed by J. C. Derham, Esq., Blackpool, and Mrs. Alfred Paine, Bedforc1. The sheet is fitted v.-ith rope bandIes and flfltachable b:1l11boo pole;>, and ma y be phced on a stretcher without dist1ll Ling the patient. Pr;ce ccmplete, 1,):>,

E.ARGE HAMPER FOR AMBULANCE STATION AND RAILWAY PURPOSES. F( r co tut!', [ce Le:xtpage.

THE HAMPER

1 Set of Cane Splints.

I Elastic Bmfl Tourniquet.

lb. Carbolic cotton} , In Tin

" 001 Cases .

! lb. Boric Lint

1 Roll Adhesive Plaster. Roller Ihnc1ages, assorted.

I tloz. Triangular Bancla,ges.

:1 pieces Tnpe.

-* oz. S11 Volatile.

<1 oz. Bicubonn,te of Soda.

<1 oz. O;i\'e Oil.

4 oz, Spirit Ether Compo

i lb. Tin Powdered Boric Acid.

4 oz. Tincture Eucalyptus B.P G,

1 pair p eJ.n's Forceps.

1 pJ.ir Scissors .

1 Knife.

12 Surgeon's N eedles,

1 packet each 'afety antI Plain Pins . oz . Carbolisel1 Twist.

1 oz. SilkwOI111 liltf.

1 reel each B lack m: c1 \Yhite 'ewing Threatl.

I Kiclllfy -shapecl Basin.

I topper Loosener .

1 Graduated Measure.

I cake 20 per cent. Carbolic Soap.

I Nail Bl'l1sh

3 Empty 8 oz. Bottles.

SMALL AMBULANCE HAMPER.

"Yit!l '\Yate!'proof Cover and Strap, for use in factories, collIerIes, tlOns, and large work s, as well as for parochial and domestIc use.

CONTAINING

1 Set ' plints. 1 Elastic :rourniquet. 3 Tampons, for washing wounds. 2 Packets Lmt. 4- Roller Bandages (wide and narrow). 4 Triangular Bandages. ' Cotton ,\Y001 } Boric Wool ::: In Tin Cases.

Spool of Adhesive Plaster.

Price complete, £4. PRICE LIST. 11

Knife, Scissors,. Thread, Tape, Needles, and Pins :

WeIght, complete, lbs.

Length, 1 ft. 6 in. Depth, 5 in. Width, 7 in. Price, £1 lIs. 6d.

!'!.ICE LIS"!'.

St:RGICAL lIAVRESAC.

IMPROVED PATTERN, fi tted wi th a tin so arranged that any article can be ta.ken out without disturbing the lest of the contents.

Contents; I et .of Splints, 6 Triangular Ranclages, 6 Roller Bandages, wIde and narrow, Cutton "Vool, Bori c Lint, .in tin cases;. I Adhesive P]a.ster, I pair Scissors, I Kmfe, 2 oz. OlIve 01], 2 oz. Tinct. Euca.]yptus B.P.C., '2 cz. al Volatile, 2 ('z. Spirits Ether Comp., 1 Graduated Glnss Measure, 1 Elastic Band Tourniquet; Pins, Needles, and Thread.

Price £1 lIs. 6d.

rRlCE LIST.

NURSES' WALLETS.

PADLOCK SHAPE.

',ithont instrument.s, 4s. 3d.

Fitted complete, containing Bow Dressing Forceps, Spatula, Probe, 2 pairs s (l'oUll'l and sharp pointerl), Clinical Thermometer, and Knife.

Price Sf'. 9L1.

ST. PA'ITERN, as ill ustratLd, but improycd by the addition of fbps to protect the insb uments.j

'Without imtnlments, 7". 2d.

Fitted complete, "ont.aining Hew Dressing Forceps, Artery Forceps (also mefnl for illessing), Sp atula, Probe, Dil ector with Ear Scoop, 2 ra:rs Scissors (round and sharp pointed), Clinical Thermometer (minute, round), Knife, Pencil, and Saf ty Pin".

Price 21:3.

FIRST AID BOX FOR LITTER OR AMBULANCE STATION.

This is primarily designed to be placed on the Ashford Litter (1899 Model). but it is further adapted to be hung up on a wall. A detachable leather handle is also fitted for carrying purposes.

For contents see next page.

OF FIRST AID Box.

(Illllstntnd on previous page)

1 Se.t of Wooden I Elastic Band Tonrniqnet; CarbolIc Wool, Boric r i nt, in tin cases; I ReI 1 Adhesive Plaster; 12 Roller B:.llldages. assorted; 6 Triangular Bandages; 3 Pie?e3 of Tape; I Pair Scissors; I Knife; I Kidneyshaped Basm; I Gl'adllated Mea,sure; 2 oz. Olive Oil· 2 oz.

Tinct. H:ucalyptus B P.C. ; 2 oz. Sal Volatile; 2 oz. ;"'pirits Ether vomp.; 8 oz. Carr011 Oil; Pins, Safety Pins, Needles, Thread.

as Braces or Tournique

First Field Dressing (Army Regulation Pattern),

All fasten or unfasten on ei ther side.

Facile No. S 600 or S 602 per doz. 0 2 Duchess Duplex, No. 2

IS 1'RICE LIST.

Ambulance Shtion Plate. Enamelled Iron. 33. 6d. each. Stretcher Depot Plate. Eaamelledll'on. 3<:. 6d. each. Nursing Chart. Designed by Miss Inderw ick. hI. each; Ly po ·t, 2d.; 1. er dozen, 9d.

Temperature Chart. I d . each; by post, 2d. ; per dozen, 9t1. ursing and Temperature in sets, to record the nursinG of a case for a fortmght, 3d.; by post, 4d. Registers. 0 Class and Certificftte (two to sell, Ca,se R3port, l:l. Bngaue Muster Roll, Large Physiological Diagrams. For Lecturer::;' C')lllprising: The Human. keleton ; the .Muscu.l:v, Altenal allLl enous Syslems; the He::trt and ClL'C.llatl?n of tl:e Blood; Fractura ; Compollml Fractllra; bon;;.

Price, per set of six, 15s. ; th7se m'Ly be lured f.or <' COUt'S) of "First Aid" Lecture", given under the of. th e Assoc iation, for a fee of 53., or with aclchtlOn of Spll nt-;, Tourniquet, and P I lin Triangu'ar Bandages, for a fee.of Boxes of Stationery for tho use of. Class n.r.d others connected with th3 Associat on, cout lInll1g tweh-o sheets of high-cbss pl.per, suitably ellvelopes bearing the d e vi ce of the A-SOCl:ltlO:J.. Pnee Gel. ; .by post, 9d. Twice tInt qU'Lntity, price I s .. ; by post,. I s. 3d.

Medallions, issued in accordance with speclU,.l re9"ulatlOns, for whi ch see No. G2, to b3 had on appllc,ltton. 13roll.zQ, 2s.; Silver, 7s. 6d ; Gold, £:2 ] 0.3.; engra.vl!lg 11 3.me and numb er on bJ.c k. Morocco vel\-et-llOod case, Small Anatomical Diagl·am. Showing tho Skeleton . Main Arteries, and poin i;s where pressure should he app lied to arrest bleeding. 2d.; by 3d.

Aide Memoire. On cardboard, in linen-l mod envc1ope, for i.he pocket . By the late.

_ Contall1i nG useful hints for FIrst AId to the I nJured, vel. ; b J post,4d.

G"'noerai Notes on First Aid to be Rendered in Cases

Poisoning. By 1I1ilnes Hey, M.A., C. '., L.R.C.P.

Price 2d.; I)y P 0 st , 3d.

PRICE LIST. I D

CLINICAL

THERMOMETERS .

Round . Ordimry, I s. 6cl.; minute, 28.; half minute, 2s.6cl.

Flat. Strongly reoommended, as they will no: roll. OnEnary,. 23. ; ditto, selected, wit.h open scale, 28. 6(1 ; rJ.pi,l (speCIally selected and reserved for the with very open s03.le, 3s. 6J.

Lense Fronted. -When held in the proper position the c.olumn of .me.rcnry magnified, and '0 easily reall. A 1?ractlCe IS reqUIred to the correct po itioll m. wbICh to holll the instrument. Price, ordinary, 2,,_ ; mInute, 2s. gel.; half-minute, Kew Certifioates (to order), Is. 3d. e.loll. K.B.-These certifioates either state that the instrumon is conect or point ou t any slight error ther.) uny lJe; t!'P)' arc not u Slu lly considered necessary.

BATH THERMOMETERS

.

'1'0 Dc. Forbes' For tb poc:-::;;>t, I s. Gll. JJp :wne'.l, ,,-ith zinc sc lIe, 2s. 3J.

TEXT BOOKS , &c

"FIRST AID TO TIlE INJURED. " Bv James Cmtlie .I.B

F.R.C.S. The autborif'ecl text book of Ad Course. ] s . ; by post, I s .

"CATECIUSM OF AID." Compiled fro111 Dr. C:.mtlie's Man ual. By J. Brown, L .R.C.P., arHI.J. M. Carvell, M.R.e.'., L .S.A. Price 6d. ; by pvst, 7el. "Hens HELP" FOR HOME NonsING AX!:> llY UmLIc." Br E. MacDo,,-.ell 90sgrJ.,'e, M.D., illnstratell, with ehapte'r on the apphCl.tlOl1 of tbe roller b.ll1clurre, by R. J. Collie

M .D. The a.ulhori"ed 'fexb book for the N nr.'l'lg ('veu'se: I s. ; by p ost, I s. 21.

20 PRICE LIST.

II HOME By John F. J. Sykes, D.Sc . (Publi c Health), &c. Illmtrated. Th e authorised Text book for the Home Hygiene COUl'S3. Is.; by post, Is. 2d. CATECHISM (b:tsed on Dr. C03gra,ve's Text-book). By J. Brown, L .R.C.P., L.R.C.S., and J. M. Carvell, M.R.C.S .. L.S.A. Priee Gel. ; bypost, 7el. AND AN3WER 'YORK." Dy John W. l\Iartin. M.D., of 'hetfie ld. and John M artin, F. R.C.S.Ed., of Hndelersfi eld . Is.; by pos t, I s. Id.

"QUESTIONS AND By John W. 1vhrtin, M.D. Is. 6d. ; by post, Is. d.

"FIRST AID TO TilE INJURED (Six:. Amhulance Lcctures) ."

By Profess'll' Frederich ES:l1arch. Translated from the Gernn.n by H .R. H. Prince3s Christian. 2s.; by post, 2s.2d.

BANDAGING SURGICAL By Walter Pye, F.R.C.S 2s.; by post, 2s. 2Ll.

DR. G. H. "FIRST AIDS," being a card to hang up, giving treatment of various accidents. 2d.; by post, 5d.

To RESTORE TIlE printed in large type with Tw;) DiagrJ.llB . Unmounted, e:lCh 2d. Mounted, with red border, aud varnished to hang up, 6<1., p ost fr ee, packed, Is.

"How TO ACT WHEN CLOTHING TAKES PIRE." By J. E. H. M ackinlay, M.R.C.S. Unmounted, 2d.; by post, 3<1. Mounted on cJ.rd and varnished, 4d.; by post, packed,7d.

PAPERS, First Aid and Nursing Course." 3d.; by post, 4d.

"EMERGEN CY BOOK," for instantaneous reference, giving in trnctions, to hang on wall. Size about one foot square . Price 2s, Gel, by pm:t 3s.

NURSING INSTRUMENTS

Bow Dressing Forceps, full size, Is. 3d.; small, extra w cll finished, I F: . Gel.

Scissors, rouml pointed, Is. 3d ; sharp pointed, for delicate w ork , I s. 3d.; stronge!', I s. 6d.; small round p oin t ed, blades t:lke apu t for delniog, I s. gel.

Spatula, gel. Probe, gel. Director, with Ear Scoop, 1;. gel. Artery Forceps, 4d. Knife, very tlun, i \' ory handle, two blades, I s 9d.

11 fjistory Of tOt Of tbt

Hospital of Sf. .1obn of

BY THE

REV. W. K. R. BEDFORD, M A ,

G .mealogist of the Order, .AND LlEUT"COLONEL R. H. HOLBECHE.

Librarian of the Order.

I n One Vcl., D(17/Y 1'0. , 2301'p.

PmCE 7s. 6d., By POST 7s. lOd.

PRICE LIST.

ROLLER BANDAGES.

I in., 6 yards long, per doz.

1 in., 6 yards long

2

ROLLER BANDAGES (in Assortment).

E ach packet contains G bandages as follows :-

G yards long -one 6 inch, two 3·inch, one l·inch; 4 yards long- two inch.

Fine Grey Calic:> per packet

Plain Triangular B:'llldagn. s . .. p er doz.

Tr:a!16 ular B.t11lhge3 (after Esnl1rch ), 21 applic:1tiom of the Triangnl ' f lJ ..Llllllge, with printed instructions

PRICE LIST.

ROLLER BANDAGE MACHINE.

Designed bv Dr. A. C. T unstall. Price 28 tid

COTTON WOOL.

White absorbent, good, 1 oz. p acket, 2d. ; 2 02. packet, 3d.> 4 oz. packet, 4d. ; lb., 7d. ; 1 lb., Is. ; superior, 1 lb., le 6d. Boracic, per lb., I s. 6d.; Car'boli'J, per lb., 1s. 8d : per lb., I s. 6d. r Double Cyanide, per lb., 2 . Cu. LINT.

. • . Medium quality, 1 oz. pack et, 2d. ; 2 oz. packet, 3d.; 4 oz. packet, 6d.; lb. packet, lOd. ; lIb. packet, I s. 6d.; Boracic lIb , packet, Is. ed.; 4oz. packet, 6d. GAiJZES.

These !.ure supplied in () yard lengths, w idth about 36 inches.

Unmedicated Whjte Alembroth

Double Cyanide

GAUZE TISSUE. B. d per length 0 9 010 1 0

A layer of absorbent cotton wool between two sheets of gauze, good per 1l:-. 1s . 6d. ; Superior, per lb. 28.

Manufactured by Messrs. A. De St. D..I.lmas & Co.

Leicester Adhesive Plaster on Cambric, in tins of yard, 6 inches wiue s. d. o 6

T he Leicester Adhesive Ribbons, in tin boxes, 6 yards

inch wide 6d. 1 inch wide Sd.

N u.tional Rubber Adhesive Plaster (Autis eptic) , on 5 yds. 111ch wide 9d.

Is. Is.9d. 10 yds. Is. Is. 6u. 2s.30.

Ditto in card box, m. wide, i yJs. long tin 1 it " :{ 5 t " 5 " COURT TRICOLonR. L arge Size, 9d. Medium, :Sd. Small, 3d.

No. 1. (ELEJ'fROTYl'E Ko. 4 .A).

Arm Badge<: , with the device issued under the authoritv of the Central Executive Committee, having been fil'st approved hy H.R.H. the Grand Prior as the sole of1icial and recognised Badges of the Associ ltioll and Brigade.

N.B.-Tlte de.igll is protected, alld must be obtained Ci'ir(ctjJ'om tIl(] C'entml Qf/ict'.

No.1, for tb.e u e of individual cerLificated pupils- 8. dIn German Sih-er ..

In Cloth :md Silver (Registej.'eel Number, 3,ij22) Z 0 In Cloth and ,VOl's! eel . . . . . . 0 6

Small Celluloid Bac1ge f0r button hole, arm, or as brooch .. .. .. .. .. 0

White Satin Armlet, wit!! woven Baelge 0 H .lY.B.-Tk·s:; Ba1,Jes are not to be worn as dccoratiom.

PRICE LIST.

BADGES.

No.2.

NO.2 for members of the St. John . Ambu.lance Brigade, the name of the Corps or Division annex,:,d.on a LLbel, only bSlled in qU1.ntities-

'In German 'ilver, first doz., £1 ; subsequent dozs. 128.

In Electro Plate, first doz., £1 12s.; subsequent dozs., £l 46.

In Cloth and Silk, per dor..,

In Cloth and Siha, per d07,., £1 lOs

All the above may be worn by merr.bers of the SL. J obn Ambulance Brigade not we3.ring umfcrm, and the German Silver and Electro Plated ma.y be worn as the Arm B.1dO'e for a.ll ra:1ks on the Brigade ITniform. 0

PRICE LIST. 27

BADGES AUTHORISED AS PART OF THE RECOGNISED UNIFORM OF THE BRIGADE.

Officers. s. d.

Co:lar Badies (Registered Kumber, 3,524) per pair 3 0

Supernumerary Cfficers.

Cap lhdge (Registered Kumber, eac-h

Al m Badge ( " ,,3,523) "

Fatigue Cap Badge for Officers antI 'eJ'geant (Registered Number, :i,fi5L)

Pouch Badge for ditto ( 3,657)

Privates.

Cap Badge (Registered Kumber, 3,521)

Arm Badge (" each

Overco:lt Badge ( " ,,1,582) "

Lady Officers of Nursing Divisions.

Ruperintenclent's Cloak Badge (Reg. Ko. 3,65,-) Arm Badge ( 3,G39)

Other Nursing Officer's Cloak Badge ( 3,555)

OLller Nursing Officer's Arm Badge ( 3,656)

Nursing Sister.

Arnl Badge Cloak Badge

Pin-cushion Badge (Registared Number, R,!'i:?:2) ( 3,521)

pecial guohtions for large quantities.

Honorary Surgeon' s Silver Wire Cross (pattern B)

Superintendent's Silver Wire Star (p3ttern A)

Medallion Bad ge (pattern D) ...

Nursing Badge (nattern E)

Satin Bad ge for Nursing Sister's Pin-cushion

Whistle and Chain

Field Service Cap. complctp. .. , each

Private 's Brown Waist Belt an..l Pouch "

White Piping. per packet of 'i yards, enough for three pairs of T! L mcn (packets C.1nnc,t be breken)

B UTTONS FOR THE U.'HFORM OF THE ST. JOHN AMBULANCE BRIGADE.

I ssued only for the usc of Officers and Members of Corps and Divisions wearing tho prescribed uniform.

Electro-plate, large

" "S111a11

Gern1'l11 Sil vel', largo ...

" " sl11a11 ...

Black Horn, large

., " small

Silver, per Cap Rtnd Black,

ELECTROTYPES OF THE ST. JOHN AMBULANCE DEVICE. Series.A

No.1. F or Cards, Tiukets &c.

" 2. F or Note Paper, Circulars, &c.

" 3. For Quarto ancl Foolscap Letter-paper,

Circular3, &c .

" 4. For Small Po del's

" 5. For Large J:>osters

Complet.e Series

Prints of the a'Love el, ctrotYI<?2 , WIth tl:e e.:';cepbon. of No.4, which is IOh0"n on p o[ e Li ple£! r en t.he toll cwmg pages.

ELECTROTYPES.

A.

No.3 A.

No.1 B. ,lJ'or pri ces lOee page 28.

No.1

PRICE LIST. ELECTROTYPES.

No.5 A.

Vor prjce see p l[C 28.

These may be obtained direct frem Messrs. Hebbert & Co., 35, Bethnal Green Road, E. Telephone No. 909 Londou \Vall; Telegraphic Address, "Otherwise, London."

BRIGADE FLAG

For marking the position of Ambulance Stations at Fetes, Exhibitions, &'c., 4 ft. in. by 3 ft. Price 12s.

All orders for the foregoing Stores should be given to the Local Secretary, or to The St. John Ambulance Association, St. John's Gate, Clelkenwell, E.C.

CHIEF SURGEON AIS"D HOSORARY SURGEON.

Tunic (Badges extra)

Trousers: Two-inch Mohair Braid down side seams

Cross-bplt and Pouch: Black, Morocco, Silver embroidered (Badge extra)

Forage Cap and Coyer CHIEF SUPT. AND OTIIER CllIEF OFFICERS.

(Badges extra)

Patrol Ja cket (Badges extra) Fatigue Jacket (Badges extra)

Two-inch Mohair Braid down side

Cross- belt, White Patent Leather and Ponch Black

(Badge extra)

PRI CE LIST.

MESS DRESS FOR OFFICER.

Jacket (Badges extra) .. .

Vest .. .

Field Cap (Badge extra)

SERGEA:KT.

Tunic, Black Melton (Badge extra)

Chevron, 3 bars ('::;ilver) .. . ...

TrouseI'S, B lack Melton

Forage Cap (Badge extra)

Cover... ... ' "

Waist·belt and Pouch

Officers' G loves (per pair) .. .

Officera' Leggings (per pair) .. .

CORPORAL.

Chevron, 2 bars (. ilver)

AND RANK AND

Patrol Jacket, Blr:.ck Tartan (Badge extra)

Trousers, Black Tartan

Forage Cap tBadge extra)

Cover for Cap .. .

Waist-belt and Pouch

Field Cap (Badge extra)

Great Coat (Badge extra)

Gloves (per pair)

Leggings (per pair)

Patrol Jacket (Badges extra) ...

Cap (Badge cxtra) '"

Breeches: Grey Serge ...

Shoulder Belt... ...

Glo\-es

Gaiters

CYCLISTS - RANK AND FILE.

Ja<:ket (Badge extra) .. .

Cap (Badge extra) .. .

Breeches: Grey serge ...

Shoulder Belt... ...

Gloves (per pair)

Gaiters (per pair)

All Badges to be obtained by the Corps or Division from St. John's Gate.

If the Corps or DiYision is out of London, measurements to be supplied to contractors free of charge.

Carriage out of London extra.

Aide 'tIlemoire

IND EX TO PRIOE LIST.

A<hforJ Litter

Badges

:Bandage Rollin6" ::-'hchine

Bandages

'Basin, Dressinl :Books

Bottles (Water) 'Braces